Carpal tunnel syndrome
In 2017 surgeons at Thomas Jefferson University Hospital in Pennsylvania published guidelines calling for a much more extensive examination of patients suffering from Carpal Tunnel Syndrome. If you have been diagnosed with Carpal Tunnel Syndrome or have been treated for Carpal Tunnel Syndrome, you may find this research enlightening.
Before you read on, if you have questions about Carpal tunnel syndrome, get help and information from Caring Medical
Here is what the research says:
- In addition to the more common carpal tunnel and cubital tunnel syndromes, orthopaedic surgeons must recognize and manage other potential sites of peripheral nerve compression.
- The distal ulnar nerve may become compressed as it travels through the wrist, which is known as ulnar tunnel or Guyon canal syndrome.
- The posterior interosseous nerve (a forearm nerve branch that travels in back of the forearm) may become entrapped in the central region of forearm as it travels through the radial tunnel, which results in a pain syndrome without motor weakness.
- The median nerve may become entrapped in the proximal forearm, which can result in a variety of symptoms.
- Spontaneous neuropathy of the anterior interosseous nerve (a forearm nerve branch that travels in the front of the forearm) of the median nerve can be observed without external compression.
- Electrodiagnostic and imaging studies may aid surgeons in the diagnosis of these syndromes; however, a thorough physical examination is paramount to localize compressed segments of these nerves. An understanding of the anatomy of each of these nerve areas allows practitioners to appreciate a patient’s clinical findings and helps guide surgical decompression.1
So do I really have Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a progressively painful hand and arm condition caused by pressure, damage, or repeated injury to the median nerve at the wrist. Since pressure on the median nerve causes carpal tunnel syndrome, then anything that crowds, irritates or compresses the nerve in the canal, can lead to the symptoms. This pressure can come from swelling or anything that would cause the tunnel to become smaller.
Wrist surgery has limited and widely varying degrees of success in treating carpal tunnel syndrome. Surgery can also make the condition worse, especially when the condition has been misdiagnosed.
Seldom do patients and athletes find relief from the “Carpal Tunnel” complaints of pain in the hand and elbow with physical therapy and surgery because the diagnosis is so often wrong. The most common reason for pain in the elbow, referring to the hand, is weakness in the annular ligament, not from Carpal Tunnel Syndrome. (Please see our accompanying article on Tennis Elbow and the Annular Ligament).
Cervical ligament weakness and annular ligament laxity should always be evaluated prior to making the diagnosis of carpal tunnel syndrome.
A physician who understands the referral patterns of these ligaments should evaluate the individual with this condition before surgery is considered. Because most physicians do not know the referral pain patterns of ligaments, they do not realize that cervical vertebrae 4 and 5 and the annular ligament can refer pain to the thumb, index, and middle fingers. Ligament laxity can also cause numbness.
As noted earlier, the pain experienced in the wrist is often referred pain and may be due to an injured or weakened annular ligament which may lead to a misdiagnosis of carpal tunnel syndrome.
Is surgery inevitable with a carpal tunnel syndrome diagnosis? Although the standard practice is to inject steroids or to prescribe anti-inflammatory medications, the end result with a diagnosis of carpal tunnel syndrome is usually surgery.
Caring Medical’s approach to carpal tunnel syndrome
In the video below Ross Hauser, MD explains Carpal Tunnel Syndrome and Pseudo Carpal Tunnel Syndrome.
Actual carpal tunnel syndromes are caused by compression of the median nerve and pseudo carpal tunnel syndromes are caused by ligament weakness. They both may present with the same or similar symptoms but have entirely different pathology.
Comprehensive Prolotherapy treatment for pseudo carpal tunnel involves multiple injections of dextrose-based solution to the various ligament attachments around the elbow or wrist. Prolotherapy to all of the injured structures stimulates a natural inflammatory response in the weakened ligament tissues. Our body heals by inflammation, and therefore when these structures are injected with this solution, the mild and localized inflammation triggers a wound healing response. Regenerative cells are sent to the areas of the wrist or elbow that need healing, and collagen is laid down. This strengthens the weak wrist and elbow ligaments. They become tighter and stronger, and the original cause of pain and symptoms is eliminated.
Platelet Rich Plasma Therapy
In a six month follow-up study, university researchers in Taiwan found that Platelet Rich Plasma Therapy effectively relieves pain and improves disability in the patients with carpal tunnel syndrome.2
In this 2017 research the Taiwanese team examined a few small reports with short follow-up periods that showed the clinical benefits of Platelet-Rich Plasma for peripheral neuropathy (see below) including one pilot study and one small, non-randomized trial in patients with carpal tunnel syndrome (CTS).
To confirm whether or not PRP was beneficial for carpal tunnel patients, they conducted a randomized, single-blind, controlled trial to assess the 6-month effect of PRP in carpal tunnel syndrome patients.
Sixty patients with single-side mild-to-moderate carpal tunnel syndrome were randomized into two groups of 30, namely the PRP and control groups.
- In the PRP group, patients were injected with one dose of 3 mL of PRP using ultrasound guidance and the control group received a night splint through the study period.
- The PRP group exhibited a significant reduction in the pain scores and improved function compared to the those of control group 6 months post-treatment.
- This study demonstrates that PRP is a safe modality that effectively relieves pain and improves disability in the patients with carpal tunnel syndrome.
Non-surgical Nerve Release and Joint Stabilizing Treatments
Nerve Release Injection Therapy is an injection technique to mechanically release the entrapped nerve and restoring homeostasis, often bringing immediate relief. This is often combined with Prolotherapy and/or Platelet Rich Plasma to address the underlying joint instability that led to the nerve entrapment.
If you have questions about Carpal tunnel syndrome, get help and information from Caring Medical
1 Strohl AB, Zelouf DS. Ulnar tunnel syndrome, radial tunnel syndrome, anterior interosseous nerve syndrome, and pronator syndrome. J Am Acad Orthop Surg. 2017 Jan;25(1):e1-e10. doi: 10.5435/JAAOS-D-16-00010. [Pubmed]
2 Wu YT, Ho TY, Chou YC, Ke MJ, Li TY, Huang GS, Chen LC. Six-month efficacy of platelet-rich plasma for carpal tunnel syndrome: A prospective randomized, single-blind controlled trial. Sci Rep. 2017 Dec;7(1):94. [Pubmed] [Google Scholar]