SIMEDHealth

Everything You Need to Know About Carpal Tunnel Syndrome

As temperatures drop this season, you may begin to feel more pain or swelling in your muscles and joints. And if you're like the 86% of American's who work at a desk all day, you might feel the symptoms of carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is considered one of the most common diagnoses in patients that present with hand pain and numbness. Simply stated, it is a condition where one of the main nerves of the hand, the median nerve, is compressed at the carpal tunnel causing symptoms typically seen in carpal tunnel syndrome. Multiple tendons that originate from the forearm that help bend your fingers and wrist and the median nerve pass through the carpal tunnel. The tunnel is composed of the carpal bones (bones of the wrist) and the transverse carpal ligament that forms a band across the base of the palm and wrist. Any condition that results in compression of the median nerve at this location is classified as Carpal Tunnel Syndrome. (see diagram)

The median nerve provides feeling and movement to the "thumb side" of the hand (the palm, thumb, index finger, middle finger, and thumb side of the ring finger).

Symptoms: 

Symptoms of Carpal Tunnel usual start gradually. This includes: pain, tingling, burning and/or numbness in the hand and fingers.  The numbness and tingling is usually first noted in the thumb, index and middle finger. It tends to spare the 5th digit (little finger). You may encounter cramping of the hand and fingers.

Patients often complain of awakening at night with the hand asleep or hand falling asleep when driving or doing a prolonged activity. Patients sometimes mention clumsiness of the hand and dropping things easily. These symptoms may also refer up the forearm and, if severe enough, to the shoulder area. If left untreated, in advanced or chronic cases, it may progress to develop weakness of the hand grip with muscle wasting (loss) under the thumb in the area known as the thenar eminence.

Causes and Risks:

Any condition that results in narrowing of the space inside the carpal tunnel compressing or irritating the median nerve can cause CTS. The most common risks include repetitive activity or trauma; repeated pressure at the wrist like resting the wrist on edge of a keyboard, overuse of the hand with prolonged typing, working in manufacturing line, using power tools that vibrate and cause injuries to the wrist and hand area. 

Additional causes include swelling of the tendons, (known as tenosynovitis), rheumatoid arthritis which causes swelling of local tissue and joints; swelling during pregnancy, (usually during second and third trimester), infections and other space occupying lesions like a ganglion cyst. Women are at higher risk to develop CTS than men and sometimes there is no identifiable cause.

Testing for Carpal Tunnel Syndrome:

The first step in properly diagnosing this condition is a taking a thorough history by your physician followed by a physical exam looking at the different possible conditions that could cause your 

symptoms. This is then followed by an electrodiagnostic study (shown on the right), also known as Nerve Conduction Study and Electromyography (NCS/EMG). There are many conditions that can mimic CTS, so the electrodiagnostic study is essential.

Inform yourself of who is performing your study. Electrodiagnostic studies should be conducted by physicians specialized in physiatry or neurology. If the NCS tests component is performed by a qualified technician, this should be performed in direct supervision of a trained physician in the field of electrodiagnostic medicine, and the EMG should only be performed by the trained physician. Unfortunately, unqualified physicians and non-physicians perform these tests and this may result in erroneous diagnosis which may result in unnecessary discomfort and improper treatment.

Treatment:

Usually begins with the avoidance of the activity causing the problem, such as stopping repetitive motion, and using proper ergonomics in the work station. The use of a wrist splint at night and anti-inflammatory drugs are commonly prescribed in order to relieve pain and swelling. Your physician may order Occupational Therapy (OT). More aggressive intervention would consist of corticosteroid injection in the wrist. If symptoms do not resolve with conservative intervention then your physician may recommend carpal tunnel release surgery. 

Because of the many conditions that can mimic CTS, surgery should not be performed unless the diagnosis is verified with an electrodiagnostic study. The surgery is commonly performed in an out-patient surgical center with regional anesthesia by an orthopedic surgeon or neurosurgeon. Note that the surgery is performed in order to release the pressure on the median nerve. The surgeon may decide to do an open surgery, making a larger incision in the palm for direct visualization of surgical field, or an endoscopic surgery, using a small endoscope through a small incision in your wrist or hand. Although carpal tunnel release surgery, in patients with mild to moderate conditions, tend to have a good outcome, it may take several months for the strength and numbness to resolve. In some cases where the condition is severe or not properly diagnosed the condition may not resolve.

If CTS is ignored or not properly treated, it may result in permanent pain, numbness, weakness and impairment. Surgical risks include but are not limited to: no improvement, increase pain due to injury of nerve or vascular structure, bleeding, infection, and scar sensitivity.

The information and recommendations appearing on this article are appropriate in most instances, but are not substitutes for proper medical evaluation and diagnosis.

If you are experience the symptoms of carpal tunnel or need medical advice, click here to request an appointment with one of our physicians, either in our Physical Medicine & Rehabilitation Medicine Division or Neurology Division.

 

This article was written by Dr. Rigoberto Puente-Guzman

 

 

Regenerative Medicine Now Offered at SIMED

Flyer for SIMED PRP Prolotherapy

Regenerative Medicine Explained

By SIMED Pain Management Dr. Rigoberto Puente-Guzman

When tissue is injured, an inflammatory process develops that begins the recovery process.  Unfortunately this inflammatory process can result in long-term tissue injury and can lead to pain, tightness, and loss of motion.  However there are ways to use the inflammatory process in a restorative fashion to minimize the long-term consequences of injuries.  Regenerative medicine utilizing your own platelet rich plasma is now offered at SIMED for treatment of acute or chronic pain conditions involving tendons, ligaments, discs, and joints.

Prolotherapy regenerative medicine with platelet rich plasma (“PRP”) injected into the injured tissue stimulates the proliferation (rapid cell growth) and repair of the injured tissue by triggering the inflammatory condition in a way that leads to tissue regeneration rather than injury.  The term “prolotherapy” is short for proliferation therapy – it stimulates the prolifera

tion and repair of injured tissue.  Current mainstream treatment options used today include:  non-steroidal anti-inflammatory drugs (“NSAIDs”), steroids, physical therapy, chiropractic strategies, splinting, bracing, ice, heat, electrical stimulation, ultrasound, and surgery.  These common treatments do the important tasks of trying to limit the extent of injury but don’t proliferate (rapidly increase) tissue repair of the injured site.

Platelet Reach Plasma (PRP) treatment is based on the theory that a high-density concentration of your circulating platelet levels isolated and concentrated can improve the natural healing capability of the body.  This is possible when platelet concentrations are increased within injured or damaged tissue.  Platelets contain key signal proteins, growth factors, chemokines, cytokines, and other proinflammatory factors that initiate and regulate basic aspects of the inflammatory cascade resulting in natural wound healing which then stimulates the proliferation, differentiation, and migration of needed mesenchymal and stromal repair cells to an injury site.

How It Works

SIMED doctor injecting Platelet Reach Plasma for regenerative medicine

Platelet Reach Plasma Prolotherapy is performed by your physician by injecting the highly concentrated PRP directly into the injured area.  This is accomplished by obtaining some of your blood using a simple, sterile venipuncture technique.  The blood is then processed in a specialized centrifuge separating the blood into three main layers:  the cellular layer containing red and white blood cells, the platelet rich layer, and the platelet poor or plasma layer.  The platelet rich layer is withdrawn from the specimen tube and then injected into the injured site (for example the knee, hip or other joints, tendons, disc, etc.).  The injection is commonly performed under ultrasound or fluoroscope imaging guidance.

After the injection, you will be instructed to avoid use of NSAIDs and steroids, as well as, avoid extraneous exercise or use of affected site for about two weeks to allow the regeneration process to take hold.  After these two weeks, the rehabilitation process with exercise and physical therapy can be started with emphasis in preserving the continued healing process by gentle range of motion and gradual strengthening exercises.  Should the benefits of PRP prolotherapy plateau prior to full recovery autologous stem cells obtained from your fat or bone marrow, combined with PRP concentrates can be an effective alternative.

Who is a candidate for PRP prolotherapy?  

Any patient that has an acute or chronic musculoskeletal pain condition may consider PRP treatment.  Although this injection can be used after standard strategies are not effective it may also be considered as first line of treatment.  Also patients who are not able to undergo surgery, or just want to avoid surgical intervention can consider PRP injections.  Common diagnosis treated include, but are not limited to joint or back pain due to arthritis, spine degenerative disc pain,  knee meniscal tears, shoulder rotator cuff tendinopathy, tennis elbow, and ligament injuries.

Who is not a candidate for PRP injection?  

Any patient with a bleeding disorder, platelet dysfunction or low levels of platelets, on blood thinning medications they cannot come off of,  chronic liver disease, diseases or illnesses suppressing the immune system, chronic 

Blood tissue regenerating during regenerative medicine

steroid use, current infections, blood or bone cancer have contraindications for this procedure.  Patients must also stop the use of NSAIDs within 48 hours of having the procedure, steroid shots at the treatment site within one month, systemic use of steroids within 2 weeks, tobacco use, and uncontrolled diabetes mellitus.  Dental work also needs to be avoid for three weeks before and after the procedure.

Although this is now a widely accepted treatment option PRP prolotherapy is still an evolving science and considered experimental by many health insurance carriers.  Therefore it is not yet a covered benefit for most insurance carriers.

You can learn more about PRP Prolotherapy and whether it’s the right treatment option for you by seeing one of SIMED’s Gainesville Physical Medicine & Rehabilitation or Interventional Pain Management physicians, or in Lady Lake/The Villages at SIMED’s Hand Center.

Call SIMED Gainesville Physical Medicine and Rehabilitation(352) 373-4321  
Call SIMED Gainesville Interventional Pain Management: (352) 224-1813 
Call SIMED Lady Lake/The Villages Hand Center(352) 751-0981