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Entrapment syndromes

  • Experience in dealing with nerve compression, even in less frequent areas.
  • Possibility of using an operating microscope whenever needed
  • Possibility of endoscopic surgery

This is a disease where the nerve is compressed by surrounding structures in its course. This most frequently occurs in areas where the nerve runs through a narrow space and is surrounded by firm tissues such as bones, ligaments and tendons even in normal circumstances. It is the distending of ligaments that is the most frequent cause of nerve compression. However, some conditions reminiscent of the syndromes mentioned below can have different causes and for the vast majority of entrapment syndromes we use electromyography (EMG) to confirm them. Besides confirming compression, this method also assesses its severity and thus the prospects of correcting the condition after surgery.

Carpal tunnel syndrome

The most frequent entrapment syndrome is carpal tunnel syndrome (CTS). The median nerve (nervus medianus) at the entrance to the palm is compressed by the distended lateral ligament of the wrist. Surgical treatment consists of a short cut in the palm and intersecting distended ligament. This releases the nerve and provides conditions for the disappearance of the problem. The operation is performed under local anaesthetic on an outpatient basis, there is no need for hospitalization and the patient is immediately discharged to home care.

Endoscopic solutions are new to our department. The advantage of this method is that a smaller incision is made outside of the palm – transversely across the wrist – and so the intervention in the working part of the palm is smaller and convalescence is quicker. The disadvantages are the longer onset of local anaesthesia and financial expenses (costs of cleaning and sterilizing the endoscope and costs of disposable instrumentation). Health insurance does not cover the higher costs and so patients have to contribute themselves.

It is crucial to pay attention to postoperative care recommendations for good healing and elimination of the problem. Treatment does not finish with the procedure itself, and good healing with minimal scarring is necessary for optimal results. The patient should move their wrist as little as possible, but moving the fingers is recommended. If the patient burdens their wrist immediately after the operation, scarring can be distended and compress the nerve again, or knitting and sources of chronic pain can develop.

Ulnar sulcus syndrome

The second most frequent entrapment syndrome is ulnar sulcus syndrome. The ulnar nerve runs just beneath the skin in the elbow area. It is stored in a bony trough (sulcus) under ligaments. The place we are talking about is the well-known “funny bone.” If the ligament is distended, for example after an increased long-term load, or if there has been trauma or inflammation, the gradual compression of the nerve can occur and limit its ability to slide in its encapsulation in movements of the elbow. The problem is manifested as pain in the elbow area and fingers. Surgical treatment consists of releasing nerve in its course and, if necessary, in moving it to a new position in the subcutaneous tissue.  The operation takes place under either general or local anaesthesia. The patient remains hospitalized until the next day and is then discharged to home care.