Carpal tunnel syndrome non-surgical

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Carpal tunnel syndrome occurs when the median nerve in the wrist is compressed or irritated.

The median nerve travels from the forearm into the hand through a "channel" in the wrist. The bottom and sides of this tunnel are formed by wrist bones and the top of the tunnel is covered by a strong band of connective tissue called the transverse carpal ligament. This tunnel also contains nine tendons that connect muscles to bones and permit flexion of the fingers and thumb. These tendons are enclosed inside a lubricating sheath called synovium which may swell under certain circumstances. If the swelling is sufficient it may cause the median nerve to be compressed, which may result in numbness, tingling in the hand.

What are the symptoms and signs?

• Numbness and tingling in the hands, especially at night and after use of the hands
• Decreased feeling in the thumb, index, and long finger
• An electric-like shock or tingling (like hitting the "funny bone") when the doctor taps over the median nerve at the wrist
• the reproduction of symptoms by holding the wrists in a flexed position for one minute

In some cases your doctor may recommend a special test called a nerve conduction study.

Anything that causes swelling, thickening or irritation of the synovial sheath surrounding the tendons in the carpal tunnel can cause pressure on the median nerve.

Some common causes and associated conditions are:

• repetitive and forceful motion with the hands
• repetitive bending of the wrist
• broken or dislocated bones in the wrist which cause swelling
• arthritis
• hypothyroidism
• diabetes
• hormonal changes associated with menopause
• pregnancy

Mild cases may be treated by applying a brace or splint which is worn at night and keeps the wrist from flexing. Resting the wrist relieves the swelling and inflammation in the synovium; this relieves the pressure on the nerve.

In more severe cases, a cortisone injection into the carpal tunnel can be helpful. This medicine relieves the pressure on the median nerve. The dosage of cortisone is usually fairly small. In fact in a recent study (Ly-pen D, et al. Arthritis Rheum 2005; 52: 612-9), steroid injection was as effective as surgery after one year of follow-up.

Other forms of non-surgical treatments include taking vitamin B-6, splints, and also exercises and massage.

Ice helps reduce swelling.

One type of treatment most doctors don't know about is very new. It is called percutaneous, ultrasound-guided, needle release. With this technique, ultrsound guidance is used to direct a small gauge needle using local anesthetic. The needle is gently inserted into the flexor retinaculum (the tough ligament that forms the roof of the carpal tunnel. The flexor retinaculum is fenestrated (pierced with a number of holes) while at the same time a mixture of lidocaine and sterile saline are used to "hydrodissect" (spread apart)the fibers of the retinaculum. It is akin to creating perforations in a piece of paper. At the end of the procedure, the wrist is flexed (bent towards the patient) and the flexor retinaculum breaks apart at the site of the perforations. No surgical incision of any type is required.

Relief is immediate with no down time.

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