Question 1

What is carpal tunnel syndrome?

Accepted Answer

Carpal tunnel syndrome (CTS) is caused by compression of the median nerve in the wrist tunnel. This carpal tunnel for nerves and tendons is formed by the carpal bones and by a band of connective tissue (transverse carpal ligament, flexor retinaculum).

Question 2

What causes carpal tunnel syndrome?

Accepted Answer

Various factors play a role. Women are affected more often than men. There is much to suggest that in some people the tunnel is too narrow from birth. Familial clusters are also noted. Overuse and constant strain on the hand, inflammatory changes in the flexor tendon sheaths or wear and tear in the wrist or carpal area can contribute to the development of symptoms. Carpal tunnel syndrome is particularly common in long-term dialysis patients. In Europe, around three in 1,000 (especially middle-aged) people are affected by carpal tunnel syndrome.

Question 3

How does carpal tunnel syndrome manifest itself?

Accepted Answer

Carpal tunnel syndrome often begins with hands “asleep” at night. As long as you can continue to sleep peacefully because your fingers can be woken up again by shaking them out, you don't have to worry. However, if the symptoms occur regularly for two to three weeks or extend into the day, it is advisable not to wait long and see your family doctor. During the day, the numbness can occur during certain activities such as cycling, driving, reading newspapers, doing the household, and holding objects. It typically affects the middle finger, index finger and thumb, and sometimes also the side of the ring finger facing the middle finger. Pain can also occur, which significantly increases the level of suffering. In many cases, weakness develops so that objects (e.g. cups) which are held with the first three fingers are dropped. In advanced stages, muscle loss develops on the ball of the thumb.

Question 4

Which examination confirms the diagnosis?

Accepted Answer

To ultimately confirm the diagnosis of carpal tunnel syndrome, an examination of the electrical conductivity of the median nerve is required. The examination is generally carried out by neurologists or neurosurgeons. It does not require needle electrodes and is largely painless. If the diagnosis is confirmed, the procedure can still be carried out even in advanced stages and in very old patients. Good treatment success may then no longer be guaranteed due to the nerve's limited ability to regenerate. With timely treatment, the symptoms usually resolve completely.

Question 5

What are the widely-accepted treatment options for carpal tunnel syndrome?

Accepted Answer

Depending on the severity of symptoms, the electrophysiologically objectified stage of nerve compression, the duration of the carpal tunnel syndrome, the (sonographic or MRI) image findings, previous therapy attempts as well as personal preference and expectations for the follow-up treatment period, the following therapy options are widely-accepted among medical specialists (without claiming to be complete):Behavioral measures and exercisesPhysical and occupational therapySplints (orthoses)InjectionsOpen surgeryEndoscopic surgeryMinimally invasive ultrasound-guided intervention

Question 6

What are the advantages of the minimally invasive intervention?

Accepted Answer

The ultrasound-guided surgical intervention is carried out on an outpatient basis under local anesthesia of the hand. Your stay in our practice will be around 1 hour. The procedure itself takes about 15 minutes and does not require suitability for anesthesia or significant pain tolerance. A button probe is first inserted through a small puncture above the wrist, followed by a very narrow hook knife. As with any surgical procedure to treat the carpal tunnel - but without a large skin incision - the transverse ligament that spans the carpal tunnel is split. It will heal in the following weeks in a relaxed state. No stitches are placed. The light pressure bandage can be removed the next morning, the steristrips after 5 days at the latest. After that, the hand no longer needs to be protected from moisture. Postoperative wound infections are almost impossible if the aftercare recommendations are followed. The hand does not need to be immobilized. Instead, finger exercises should be started the day after the procedure and the patient should be conditionally fit for everyday life within a few days. Depending on the type of strain, patients can usually return to their professional activities after 2 to 3 weeks. In patients who do heavy manual work or are competitive athletes, the full load build-up can be extended in individual cases until the end of the 4th week. After that time period, significant restrictions due to pressure pain over the wrist are rare.

Question 7

Who carries out the minimally invasive procedure?

Accepted Answer

Ultrasound-assisted carpal tunnel release was established in Europe primarily in France and further developed by nerve sonography specialists at the University Hospital Innsbruck, Austria. Because it does not require any major incisions, it is called minimally invasive. Patients come for an outpatient procedure that lasts around 15 minutes and then go home without a suture/stitches. Ultrasound-targeted procedures are a domain of interventional radiology, which is why this treatment of carpal tunnel syndrome is primarily offered by radiological specialists. In his private practice, Dr. Kau carries out all procedures personally with the support of his team.

Question 8

What can typically be expected after the procedure?

Accepted Answer

As with any operation, moderate pain in the hand can be expected for a few days, depending on individual sensitivity. If necessary and tolerated, these can be treated with simple painkillers. Mild temporary hematoma discoloration of the wrist skin is common. In some cases, a small amount of bruising and swelling of the hand may occur after the procedure. Slight tenderness on the thumb ball, dysesthesia of individual fingertips and occasionally "electrifying" sensations along the median nerve in the forearm are normal for several weeks after any type of carpal tunnel release, but are not the rule. As soon as the local anesthesia wears off (1 to 3 days after the procedure), the (nighttime) pain of carpal tunnel syndrome can be expected to subside. As the relieved nerve recovers, sensitivity and strength usually return over the next few days to weeks. In particularly severe cases or long-standing carpal tunnel syndrome, the nerve may not fully regenerate even 6 months after the procedure. However, an improvement in symptoms can be observed in almost all cases.

Question 9

What speaks for a carpal tunnel release procedure in the private practice of Dr. Kau?

Accepted Answer

As a private specialist, I personally take time for you. My team and I strive to create a relaxed, professional atmosphere. Your privacy and your individual situation are important to us. As a specialist in neuroradiology and radiological interventions with extensive experience in carrying out ultrasound-guided procedures, I can offer innovative medicine with the necessary routine. The minimally invasive procedure takes place in a well-rehearsed setting. A first-class ultrasound device is used both for the assessment and during the procedure.

Question 10

How do I get an appointment at the private specialist practice of Dr. Kau?

Accepted Answer

Online booking via this website gives you a good overview of available appointment times for all services offered. You can also send us an appointment request by email or contact us directly by phone. If you cannot reach us immediately, we will call you back as soon as possible.

Question 11

Does Dr. Kau treat international patients in his private practice?

Accepted Answer

The innovative procedure of ultrasound-targeted carpal tunnel release, which is not yet very widespread in Europe, is aimed at privately insured people and self-payers. International patients are expressly welcome. The patient interview, information and consent are given in English or German. A positive electrophysiological finding for the nerve conduction velocity of the median nerve is a prerequisite for the procedure. Please remember to bring these results and current blood labs (blood count and coagulation) with you! Coming from abroad, please consider spending 1 night in a hotel/private accommodation, as the medical consultation and the procedure cannot take place on the same day for legal reasons. The follow-up examination in the private practice 3 weeks after the procedure is not absolutely mandatory and may be skipped in the typical case of unremarkable postoperative course. However, we then strongly recommend tele-consultation of Dr. Kau on a regular basis. In any case of unexpected or unfavourable course, please do not hesitate to see your family physician or primary healthcare center at your home place without delay and contact us remotely. The city of Villach, Austria, is located at a motorway junction and has a Railjet train station. The international airports Klagenfurt (AUT) and Ljubljana (SLO) are within taxi distance. The airports Graz and Salzburg (AUT), Trieste and Venice (ITA) can be reached by car in 1.5-2.5 hours. By public transport, you can reach us in less than 1 hour from Klagenfurt airport, in less than 2 hours from Graz airport, and in less than 3 hours from Salzburg airport.Direct flights from London, GB, to Klagenfurt (Ryanair), to Graz (British Airways), and to Ljubljana (EasyJet)! We are happy to help you plan your visit.

Question 12

What should you bring to your initial consultation when preparing for a possible carpal tunnel release intervention?

Accepted Answer

The initial contact in the private practice (or online) can take place at any reasonable time before the desired operation date. The medical consultation can take place in this setting, but best no later than 3 days and in any case no later than 1 day before the procedure. Ideally, please provide the electrophysiological findings (nerve conduction velocity) of the median nerve and a list of your current medication (particularly anticoagulants) to the initial consultation.

Question 13

What documents should you bring with you on the day of the procedure?

Accepted Answer

Please bring current blood labs (blood count and coagulation), the signed consent form and - if not already provided for the initial assessment - the electrophysiological findings (nerve conduction velocity) for the median nerve of the respective hand with you on the day of the procedure!

Question 14

What are the costs for a minimally invasive carpal tunnel release procedure?

Accepted Answer

Our offer with transparent cost presentation is aimed at privately insured patients and self-payers. In general, we recommend that you obtain confirmation of cost coverage from your private medical insurance. We would be happy to provide you with a cost breakdown for this. The 30-minute appointment for the initial consultation includes the specialist consultation, a sonographic evaluation, and any explanatory discussion. The tariff for the surgical procedure naturally includes all services, instruments, medication and personnel resources. The planned follow-up examination 3 weeks after a carpal tunnel release is not charged separately. Further check-ups are rarely necessary and are billed individually in each case.Please feel free to contact us for an individual cost estimate!€ 1.980Raiffeisen Landesbank KärntenIBAN: AT57 3900 0000 0273 9712

Question 15

What does my insurance cover and where should I submit the doctor's bill?

Accepted Answer

International patients are kindly requested to transfer the fee of €1,980 to our account (free of charge for the recipient). The total amount must reach the practice's bank account prior to the scheduled procedure. Should the procedure not take place for any reason, the amount will, of course, be fully refunded.Raiffeisen Landesbank KärntenIBAN: AT57 3900 0000 0273 9712

Question 16

Can I travel to Villach for a carpal tunnel release procedure from abroad?

Accepted Answer

Yes. Many of our patients travel from the UK, Germany, Switzerland, Slovenia, Croatia, and Northern Italy specifically for this procedure. Villach is well connected: it lies at the A2/A10/A11 motorway intersection, and the railway station is within walking distance of the practice. Klagenfurt and Ljubljana airports are reachable by taxi; Graz, Trieste, and Venice airports are within 1.5–2.5 hours by car.

We recommend planning at least one hotel night to allow sufficient time between the initial consultation (which must take place at least one day before the procedure) and the outpatient intervention. The 3-week follow-up can be replaced by a complimentary teleconsultation for patients returning home.

Question 17

What do I need to bring from abroad for the carpal tunnel procedure?

Accepted Answer

You will need: a recent nerve conduction velocity (NLG/EMG) study confirming median nerve compression at the carpal tunnel, and a current blood laboratory result (full blood count and coagulation). If you have a referral from your local specialist, please bring that as well. All documents can be in English or German.

Informed consent must be signed at least one day before the procedure, so a two-day stay in Villach is the standard recommendation for international patients.

Question 18

Does private health insurance cover the procedure for international patients?

Accepted Answer

Most private health insurance policies covering surgical procedures abroad will reimburse the cost of the procedure. We recommend contacting your insurer in advance to confirm coverage. We are happy to provide a detailed cost estimate for your insurer upon request.

UK patients: the NHS S2 route only applies to state hospital treatment; private specialist practices like ours are not covered under S2. Self-pay patients are welcome.

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