What is carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) is a common nerve compression disorder in which the so-called median nerve is constricted in the wrist area. This nerve runs through the carpal tunnel, a narrow channel bordered by carpal bones and a firm ligament (flexor retinaculum). The carpal tunnel serves as a passageway for the median nerve and tendons that are responsible for the movement of the fingers.

What symptoms are associated with CTS?

Compression of the median nerve leads to various symptoms that can increase in intensity as the disease progresses. Common symptoms are:

• Tingling and numbness
  • CTS often begins with ‘formication’ in the hand, which can intensify over time.
  • Tingling and numbness are usually felt in the thumb, index finger, middle finger and parts of the ring finger.
  • Those affected often complain of their hand ‘falling asleep’, especially at night.
• Pain
  • CTS is also usually accompanied by pulling or burning pain in the wrist, which can radiate into the fingers or arm.
  • The pain is worse at night or during certain movements.
• Feeling of weakness
  • Carpal tunnel syndrome also often leads to difficulties in gripping or holding objects (e.g. cup).
  • Strength, especially when gripping with the thumb, may be reduced.
• Feeling of swelling
  • Many sufferers have the subjective feeling that their fingers or wrist are swollen, even if no external thickening is visible.
• Fine motor impairments
• • Due to the compressed median nerve, there are often problems with fine motor tasks, such as opening a screw cap or buttoning clothes.
• Nocturnal symptoms
  • In most cases, the symptoms are particularly severe at night. Many patients wake up with pain or numbness in the hand.
  • Shaking the hand often only brings temporary relief.
• Advanced signs
  • Untreated carpal tunnel syndrome can lead to permanent numbness.
  • In the advanced stage, the muscle in the area of the ball of the thumb (thenar muscle) can degenerate, which further restricts the mobility of the thumb.

What are the causes of CTS?

The causes of narrowing of the carpal tunnel are varied and can be favoured by various factors. Possible triggers include:

• Repetitive strain and overuse
  • Monotonous movements such as typing or manual labour can permanently irritate the tendon sheaths.
  • Work that repeatedly exerts pressure on the wrist (e.g. lifting heavy objects, supporting the hands) further increases the risk.
• Inflammatory processes
  • Repeated inflammation of the tendon sheaths can reduce the space in the carpal tunnel.
  • Joint diseases such as osteoarthritis or rheumatism often lead to swelling and inflammatory changes that can narrow the carpal tunnel.
• Hormonal changes
  • Water retention and swelling in the tissue are common during pregnancy and can increase the pressure in the carpal tunnel.
  • Hormonal fluctuations (e.g. during the menopause) can also lead to water retention or tissue changes.
  • In addition, an underactive thyroid can favour swelling of the tissue and thus a narrowing of the tunnel.
• Mechanical causes
  • Bone fractures or misalignments in the wrist can change the structure of the carpal tunnel and thus trigger CTS.
• Diseases
  • High blood sugar levels due to diabetes mellitus can make the nerves more sensitive and increase the risk of developing carpal tunnel syndrome.
  • Obesity can also lead to increased pressure in the carpal tunnel.
  • Renal insufficiency can cause water retention and tissue swelling.
• Genetic predisposition
  • A hereditary connection may also play a role, as the size and shape of the carpal tunnel vary from person to person.

What to do with carpal tunnel syndrome?
Step 1: Diagnostics

A precise diagnosis is crucial in order to clearly determine the cause of the symptoms and to differentiate between carpal tunnel syndrome and other conditions such as nerve root compression in the cervical spine. The diagnostic procedure is as follows:

Medical history
The first step is to clarify your individual symptoms and their progression. Typical questions are:

• When and how often do the symptoms occur?
• In which fingers do you feel the tingling or numbness?
• Do the symptoms get worse at night?
• Are there any activities that trigger or intensify the symptoms?

We will also ask you about risk factors such as diabetes, rheumatic diseases or occupational stress.

Physical examination
In the next step, we check the function of your hand by carrying out various tests:

• Tinel test
  Light tapping on the carpal tunnel can cause tingling or pain.
• Phalen test
  When the wrist is flexed for about a minute, typical symptoms such as formication or numbness often occur.
• Ball of thumb examination
  We also check whether there is weakness or atrophy of the muscles in the thumb area.

Electrophysiological examinations
Measurements of nerve conduction can be carried out for further clarification:

• Electroneurography (ENG)
  This tests the conduction velocity of the median nerve. A slowdown indicates damage or compression.
• Electromyography (EMG)
  This examination determines the activity of the muscles and shows whether there is already muscle damage due to the impaired nerve.

Imaging procedures
In some cases, additional imaging diagnostics may be necessary. These include, for example

• Ultrasound
  Sonography shows a possible thickening of the median nerve or changes in the carpal tunnel.
• MRI
  Particularly in unclear cases, magnetic resonance imaging provides detailed images of your wrist and the surrounding structures.

What to do with carpal tunnel syndrome?
Step 2: Treatment

The treatment for carpal tunnel syndrome depends on the severity of the condition and your individual symptoms. The aim is to reduce the pressure on the median nerve, alleviate pain and restore the functionality of the hand. There are conservative and surgical treatment options:

Conservative treatment
These approaches are used particularly in the early stages of CTS or for mild symptoms:

• Immobilisation of the wrist
  Wearing a wrist splint (especially at night) prevents the wrist from bending and relieves pressure on the median nerve.
• Medication
  Anti-inflammatory medication can reduce swelling and relieve pain.
  In cases of severe inflammation, we can administer a cortisone injection directly into the carpal tunnel.
• Physiotherapy and occupational therapy
  Special exercises to stretch and strengthen the hand and forearm muscles promote mobility and blood circulation.
  Occupational therapy helps to prevent incorrect posture and relieve the hand in everyday life.
• Lifestyle changes
  It is also advisable to reduce stressful activities – such as repetitive movements at work.

Surgical treatment
If conservative measures do not bring sufficient improvement or the symptoms are already advanced, surgical intervention may be advisable.

• Aim of the operation
  The aim of surgery for CTS is to relieve the pressure on the median nerve. To do this, we cut the carpal ligament, which creates more space in the carpal tunnel.
• Procedure of the operation
  We make a tiny incision in the area of your wrist to expose the carpal ligament and cut it with fine instruments. Cutting the ligament usually has no negative effects on hand function. Your body adapts after the procedure and the resulting scar tissue provides sufficient stabilisation. In rare cases, minimal loss of strength may occur. However, these can usually be compensated for with targeted physiotherapy.
• After the procedure
  We recommend starting light movement exercises at an early stage to promote mobility. Complete healing usually takes a few weeks to months, depending on the severity and individual regeneration.

What to do with carpal tunnel syndrome? Have yourself examined by hand surgeon Dr Isabella Gruber in Frankfurt

When it comes to treating complaints such as carpal tunnel syndrome, Dr. Isabella Gruber from our private practice for orthopaedics and traumatology in Frankfurt is your ideal contact. With her expertise in hand surgery and her focus on gentle and sustainable treatment methods, she offers you comprehensive care – from the initial diagnosis to aftercare.

Dr Gruber combines the highest level of medical expertise with a sensitive and individual approach that is tailored to your personal needs. Whether conservative treatment approaches or surgical interventions – you are in good hands with Dr Gruber. Our practice is also characterised by state-of-the-art equipment and a well-coordinated team that is at your side at every stage of treatment. Make your appointment now!

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Biceps tendon tear on the arm

A biceps tendon injury can result in the tearing of a portion of the tendon that attaches the biceps muscle to your shoulder or forearm. The biceps muscle is largely responsible for bending the elbow joint and consists of three tendons. In the upper area, it is connected to the shoulder via two tendons (long and short biceps tendon) – in the lower area, it is connected to the forearm via a common tendon. Tears in the forearm area often occur suddenly due to intense tension. Tears in the shoulder area are usually caused by degenerative changes in the shoulder joint. Prolonged shoulder discomfort often precedes a tear.

Typical symptoms of a rupture of the biceps tendon

• Sudden, stabbing pain
• Audible “pop”
• Large bruise on the forearm and in the area of the flexor elbow joint
• The biceps muscle pulls back, when tensing it shifts upwards

Therapy in Frankfurt
Injuries to the shoulder and elbow have different effects. In the case of forearm injuries, a major loss of strength in flexion and external rotation of the forearm usually leads to surgical treatment, especially in younger patients. In this case, the tendon is reattached to the attachment on the forearm with the help of suture anchors.

In the case of tendon rupture at the shoulder, the loss of strength is less, and treatment is usually without surgery.

Rupture of the extensor or flexor tendons of the hand

Hand tendon injuries can result in tears, bony avulsions or severances of the affected tendons. Sharp severances of the tendon often occur due to injuries with broken glass or knives. A bony avulsion of the tendon can result from violent bending or extending movements of the fingers. Sometimes a tendon tears even without a direct (sports) accident, for example, due to inflammatory or rheumatic diseases.

Typical symptoms of a tear of the extensor or flexor tendons of the hand

• Restricted movement of the fingers or hand
• Malpositioning of the fingers
• Pain
• Swelling
• Bruises

Therapy in Frankfurt
A thorough physical examination is crucial in hand tendon injuries, and we pay particular attention to the type and extent of movement restrictions in the fingers. To rule out possible bone injuries, it often requires an X-ray examination.

Treatment options for injured tendons are varied and depend on the type of injury. We can often successfully treat extensor tendon injuries in the front of the fingers with a splint or cast without surgery.

Flexor tendon injuries usually require surgical treatment, which should be performed promptly after the injury to suture the tendon. If treatment is delayed, a tendon graft is sometimes required.

Tear of the quadriceps or patellar tendon at the knee

Both tendons attach to the kneecap (patella). A rupture of the quadriceps tendon is the rupture of the tendon that connects the thigh extensor (quadriceps muscle) to the kneecap. In the case of an affected patellar tendon, the tendon that runs from the lower pole of the kneecap to the lower leg tears. Both tendons are part of the extensor apparatus of the leg and transmit force from your thigh to your lower leg. Tendon rupture usually occurs due to degenerative changes in the tendons. Acutely, it can also be caused by severe muscle strain in a flexed position of the knee joint, and less commonly by direct trauma to the kneecap.

Typical symptoms of a tear of the quadriceps or patellar tendon at the knee

• Loud cracking in the knee
• Swelling soon after
• Restricted ability to walk / running often no longer possible at all
• Reduced strength when stretching the knee joint
• Instability of the knee
• Inability to move the knee

Therapy in Frankfurt
In this case, surgical treatment is usually required. The tendon is either sutured or, in the case of tears close to the bone, reattached to the bone.

Rupture of the Achilles tendon on the foot

The Achilles tendon transmits the force of the calf muscles to the heel bone and allows the movement where you can lower the toe down. This allows you to stand on your toes or push off the ground when running or jumping. Although the Achilles tendon is the strongest tendon in the human body, it can tear. External trauma is rarely the cause. In most cases, there is a chronic change in the tendon. The tear then occurs due to sudden strain or abrupt stopping.

Typical symptoms of tendon rupture of the Achilles tendon in the foot

• Sudden, whip-like pop
• Sharp pain above the heel and in the calf
• Limited ability to walk
• Therapy in Frankfurt
• First, a careful ultrasound examination of the tendon is performed to determine if the ruptured tendon ends are sufficiently approaching in a pointed foot position. If this is the case, conservative therapy can be performed in a special lower leg boot.

If the tendon ends are too far apart or the tendon is torn directly at the calcaneus, surgery is required.

Also possible: partial tear of a tendon

In a partial tendon tear, the tendon in question is partially, but not completely, torn away from its attachment point to bone or muscle. This type of injury falls between a tendon strain, in which the tendon is overstretched or irritated, and a complete tendon tear, in which the tendon is completely separated.

Causes of a partial tear of a tendon can include acute trauma, overuse or degenerative changes. For example, a sudden fall or heavy load can damage the tendon and cause a partial tear. With repetitive stress or chronic overuse, the tendon may gradually wear down and tear.

Symptoms of a partial tear of a tendon may include pain, swelling and dysfunction in the affected region. The severity of symptoms depends on the degree of the tear.

Treatment can be conservative and includes rest, physical therapy, anti-inflammatory medications and targeted exercises to strengthen the muscles around the injured tendon.

Other tendon injuries with similar symptoms

There are other tendon injuries or conditions where the tendon is not torn but causes similar symptoms.

These include:

• Inflammation of the tendon and tendon sheath.
• Strains
• Tendon slippage
• Tendon calcification
• Tendon dislocation
• Tendon tissue thickening

You can learn more about the individual tendon diseases here: Tendon injuries Frankfurt

Diagnostics and treatment of tendon ruptures in Frankfurt

It is important to seek medical attention immediately if a tendon tear is suspected. Early diagnosis and treatment can greatly improve the chances of recovery. Untreated tendon tears can lead to long-term dysfunction and complications, so you should take the injury seriously.

At our private practice for orthopedics and traumatology in Frankfurt, we specialize in the diagnosis and treatment of a wide variety of injuries. We have a state-of-the-art, high-resolution ultrasound as well as a fully digital X-ray machine to examine your tendons. Since we are also experts in the field of sports medicine as well as sports injuries, we are also your perfect contact in Frankfurt for all these issues.

We can complement the respective conservative treatment with, for example, PRP treatment, acupuncture or kinesio-taping in our practice in Frankfurt.

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Causes of tendon injuries

Tendon injuries can occur in a number of ways.

Poor warm-up and stretching
Inadequate warm-up and stretching before exercise can make tendons less flexible and increase the risk of injury.

Overuse
Tendon injuries are often the result of chronic overuse. Repeated, intense stress on the tendons, without adequate rest and recovery, can lead to microtears. This often occurs in sports that require repetitive movements such as running, tennis, golf or baseball.

Trauma
Acute injuries, such as sudden impacts or falls, can lead to tendon tears. For example, a fall on the extended leg can lead to an Achilles tendon tear.

Incorrect posture and inadequate technique
Incorrect posture or inadequate technique during certain activities can place excessive stress on tendons. This is often the case with weight training or sports involving explosive movements. These are fast and powerful activities in which the muscles release a high amount of energy in a short period of time to produce maximum power. These are for example jumps, sprints and throws.

Age
As we age, the elasticity and strength of tendons decreases, increasing the risk of tendon injury. This is a natural process and can lead to injury.

Anatomical factors
Some individuals have a higher risk of tendon injury due to their anatomical structure. For example, an abnormal tendon path can increase the risk.

Medications and diseases
Certain medications, such as fluoroquinolones, can make tendons more unstable, making you more likely to injure them. In addition, diseases such as rheumatism or diabetes can make tendons more vulnerable.

Inflammation, tear and strain: the most common tendon injuries

Tendon inflammation (tendinitis)
So-called tendinitis is an inflammation of a tendon. In this case, it is irritated and swollen. This causes pain that usually occurs near the affected tendon. The pain often intensifies with movement or strain on the affected region, with limited functionality. The affected region may feel stiff, especially in the morning or after prolonged rest. In some cases, the skin over the affected tendon may also be red and warmer than the surrounding skin.

The cause is usually overuse, e.g. due to repetitive movements, incorrect technique in sports or unfavorable workplace conditions.

Typical examples of tendonitis are Achilles tendonitis and tennis or golfer’s elbow.

Tendon strain
Another possible tendon injury is a strain. It occurs when a tendon is stretched beyond its normal extent. Again, there may be pain, swelling, redness and sometimes bruising at the affected area. The severity of the stretch can vary from mild to severe.

Tendon strain can occur when a tendon is abruptly or excessively stretched, for example, by a sudden impact, a strong tensile load, or a rapid movement. Repetitive motions or stresses that strain a tendon over a long period of time can also cause it. This often occurs in sports or occupational activities that require repetitive motion. If you do not warm up or stretch adequately before exercising or doing physical work, this can increase your risk for a pulled tendon.

A typical example is the strain of the tendons in the thigh area (quadriceps tendon strain).

Tendon rupture
When a tendon partially or completely ruptures, it is called tendinosis. Tendon rupture is usually accompanied by severe, sudden pain near the injured tendon. The pain can be so severe that it significantly restricts movement of the affected area. In addition, there is swelling. Since the small blood vessels near the torn tendon are usually damaged as well, there is also a bruise in most cases.

A tendon rupture can significantly affect the normal function of the muscle associated with the torn tendon. This often leads to a noticeable loss of strength as well as a restriction of movement.

The causes are, for example, accidents or overuse of the tendon. Degenerative changes, as can occur through the natural aging process, or congenital malpositions are also often to blame for ruptures. Tendon ruptures are also common sports accidents or the result of improper technique during training.

Typical examples are the rupture of the biceps tendon or the patellar tendon.

You can also read more about this topic here: Tendon rupture: What happens when a tendon tears?

Other types of tendon problems

In addition to the typical tendon injuries mentioned above, there are other problems that can affect tendons. For example, various other conditions can also be associated with pain, dysfunction and limited movement:

Tendovaginitis
In a condition called tendovaginitis, the tendon sheath (e.g., in the elbow), a protective tube that surrounds and lubricates the tendon, becomes inflamed.

Tendon slippage
This is a problem in which the tendon does not slide smoothly in its tendon sheath. This is referred to as tendosynovitis. The wrists are often affected here.

Tendonosis
This is a condition in which calcium deposits occur in the tendon. Tendinosis calcarea often occurs in the shoulder (calcareous shoulder).

Tendon dislocation
Sometimes a tendon can slip or slide out of its normal position. This can cause it to shift. This is called tendon dislocation. An example is flexor tendon luxation in the fingers.

Tendon tissue thickening
In this condition, the tissue of the tendon thickens abnormally, for example, at the knee.

Diagnostics and therapy for tendon injuries in Frankfurt

It is important to take tendon injuries seriously and seek medical attention to ensure the best possible recovery.

If you have had an accident or suddenly notice pain, limited range of motion or other problems that may indicate tendon injuries and disorders listed above, please make an appointment with our private practice for orthopedics and traumatology in Frankfurt.

We specialize in the diagnosis and treatment of a wide variety of injuries. In addition, we are also experts in the field of sports medicine and sports injuries. To find out what exactly is wrong with you, we work with a modern, high-resolution ultrasound machine as well as a fully digital X-ray machine.

The particular treatment depends on the type and severity of your individual tendon problem. Therapy may include immobilization with bandages and orthotics, physical therapy, anti-inflammatory medications and targeted exercises to strengthen the muscles around the affected tendon. Peri- and intra-articular infiltrations, PRP treatment, shock wave therapy, acupuncture or kinesio-taping in our practice in Frankfurt are also possible.

In severe cases, surgery may be necessary.

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The difference between osteoarthritis and arthritis

Profile Osteoarthritis: When joint cartilage is irreparably damaged
Osteoarthritis is a degenerative joint disease in which the cartilage in one or more joints is worn away and damaged. Cartilage normally has the job of protecting joints and allowing them to move smoothly. However, in osteoarthritis, it gradually becomes thinner. It may even wear away completely, causing the bones to rub directly against each other. The worn cartilage and bone surfaces can be painful and cause inflammation in the joint. This can lead to symptoms such as pain, stiffness, swelling and limited mobility. Osteoarthritis often occurs in joints such as the hands, knees, hips and spine, but in principle can affect any joint.

Profile Arthritis: Inflammatory joint disease
Arthritis is an inflammatory disease of the joints that causes swelling, pain and limited mobility. There are several forms of arthritis, the most common being rheumatoid arthritis and osteoarthritis. Rheumatoid arthritis is an autoimmune disease in which the immune system mistakenly attacks healthy tissue in the joints. This leads to inflammation and damage to the joint cartilage and surrounding tissue. Rheumatoid arthritis usually affects several joints at once and can also damage other organs and tissues in the body. Osteoarthritis, also known as degenerative joint disease or “wear and tear” arthritis, occurs when the cartilage in the joints gradually breaks down. Aging, long-term overuse of joints, injury, congenital joint defects, infection, gout or metabolic disorders can cause osteoarthritis.

Osteoarthritis therapy in our practice in Frankfurt

Treatment for osteoarthritis generally aims to relieve pain, reduce inflammation, improve joint function and prevent progression of the disease. Specific treatment methods may vary depending on the severity of the osteoarthritis and the joints affected.

At our private practice for orthopedics and traumatology in Frankfurt, we offer careful examination and consultation as well as:

Peri- and intra-articular infiltrations.
In this procedure, we inject anti-inflammatory substances into the affected joint or the surrounding soft tissues. In this way, we can improve the effects of painful overuse or incorrect strain syndromes as well as signs of wear and tear.

Autologous blood therapy
For this purpose, we use your own blood and prepare it so that we can inject the platelet-rich plasma it contains into the inflamed areas. You can also learn more about the mode of action here: “PRP therapy for osteoarthritis“

Kinesio-Taping
We apply special tapes to your muscles or tissues, which have a relaxing and stabilizing effect on the joint structures.

Acupuncture
This procedure is based on Traditional Chinese Medicine. By inserting fine needles into your tissue, we create a mild and harmless inflammatory stimulus that stimulates your body. This can cause improved blood flow to the affected area, while also having anti-inflammatory and pain-relieving effects.

Conservative treatment, aids, physiotherapy & co.
We can also use painkillers such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain. For more severe pain, we can also prescribe stronger painkillers. Bandages and orthotics, as well as physical therapy, have continued to prove effective.

Arthritis therapy in our practice in Frankfurt

In the case of joint inflammation, there are various ways to relieve acute discomfort. Anti-inflammatory drugs and painkillers can provide short-term relief. However, long-term measures also play an important role in treatment. Careful mobilization of the affected joints can help you reduce symptoms and improve mobility. Physical therapy and occupational therapy offer specific exercises and techniques to strengthen joint function and relieve pain.

Dietary changes can also have positive effects. A balanced diet rich in anti-inflammatory nutrients such as omega-3 fatty acids, antioxidants and fiber can help reduce inflammation in the body. Depending on the exact diagnosis, the use of specific medications may also be useful. In the case of rheumatoid arthritis, we may also work with a rheumatologist.

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