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Carpal Tunnel Syndrome
Carpal Tunnel Syndrome is a condition whereby the median nerve in the wrist is compressed. A group of tendons travel through the carpal tunnel along with the nerve. Swelling or inflammation of the tendons or nerve causes pressure and compression of the median nerve (shown in blue in the image above). The median nerve is a mixed nerve, meaning it has a sensory function (provides feeling) and also provides nerve signals to move your muscles (motor function). The median nerve provides sensation to your thumb, index finger, middle finger and the middle-finger side of the ring finger. Problem with the nerve causes numbness (often worse at night or upon awakening in the morning), tingling, pain and weakness of the grip.
Common causes of Carpal Tunnel Syndrome
Although it might seem that carpal tunnel syndrome is a condition born from long hours spent working on a computer keyboard, it actually has numerous causes.
Bound by bones and ligaments, the carpal tunnel is a narrow passageway — about as big around as your thumb — located on the palm side of your wrist. This tunnel protects a main nerve to your hand and nine tendons that bend your fingers. Pressure placed on the nerve produces the numbness, tingling, pain and, eventually, hand weakness that characterize carpal tunnel syndrome. Carpal tunnel syndrome typically starts gradually with a vague aching in your wrist that can extend to your hand or forearm.
Common Symptoms include:
Numbness or tingling, pins and needles in the first three fingers and part of the ring finger
Pain radiating or extending from your wrist up your arm to your shoulder or down into your palm or fingers, especially after forceful or repetitive use. This usually occurs on the palm side of your forearm.
A sense of weakness in your hands and a tendency to drop objects.
Waking at night or during the day having to shake your hands out to wake them up
Hands falling asleep when you keep them in one position.
Why is diagnostic ultrasound important when examining the Carpal Tunnel and Wrist?
Unlike an x-ray, which emits radiation and shows only bone, diagnostic ultrasound is non-invasive, allowing us to view the causes of your wrist and hand pain with great accuracy. The bundles of tendons and the sheath that surround them can be examined for signs of swelling or inflammation. The nerve can be measured within the Carpal Tunnel and compared with normal values to obtain a preliminary diagnosis. If the symptoms are only on one side, the symptomatic side can be compared with the non-symptomatic side.
With musculoskeletal ultrasound imaging (MSUS), the muscles, tendons, ligaments, cartilage and nerves can be accurately examined at the time of your visit. No referrals are needed and there is no waiting for the test results!
Patent with right hand symptoms: Left wrist and right wrist side-by-side on the same film for comparison showing an enlarged right median nerve and swollen tendons consistent with Carpal Tunnel Syndrome.
Below is a different viewing angle of the same patient as above.
Left wrist and right wrist side-by-side on the same film for comparison showing an enlarged right median nerve and swollen tendons in a different viewing angle consistent with Carpal Tunnel Syndrome.
EMG/NCV nerve testing is also done in some cases and measures the degree and severity of changes in nerve function. The nerve test measures the speed at which the nerve signal travels as it passes through the carpal tunnel. With Carpal Tunnel Syndrome the speed of the nerve impulse is slowed down due to compression of the nerve.
Most patients we see are told there is no treatment other than surgery. That is not true in many cases we care for.
Have you tried Physical Therapy in the past and it hasn’t worked for you?
A Different Approach Other Than Routine Painful Exercises:
We see many patients who come to us in chronic pain. Many have also had experience with physical therapy where they spent much of their sessions doing exercises and it hasn’t helped. Think of being in pain, having joint stiffness, loss of range of motion or chronic inflammation and then doing exercises to get rid of it. In most cases, you’ll feel worse not better.
Exercise is critical to maintain proper joint strength, but done at the wrong time and your pain often becomes worse. That is why we take an entirely different approach with treatment plans using three phases:
Our physical therapy team specializes in using certain modalities like electrical stimulation or ultrasound to reduce swelling and inflammation and increases local circulation to help the healing process. Different modalities can be applied to successfully address spasm, trigger points, inflammation, edema, swelling and damage from tendonitis and tears.
Joint Release Techniques:
Techniques are done by hand to gently stretch, massage and release the pressure in each of the muscles, tendons and ligaments surrounding the joint. The result is a soothing improvement in joint pain.
The Selective Functional Movement Assessment:
Our physical therapy team is certified in the Selective Functional Movement Assessment (SFMA), which is a series of 7 full body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known joint pain. When the clinical assessment is initiated from the perspective of the movement pattern, our therapy team has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main joint pain complaint, but contribute to the pain.
Think of having a painful right knee and favoring that side for an extended period of time. Following a period of uneven gait you may develop pain on the opposite unrelated side. This concept, known as Regional Interdependence, is the hallmark of the SFMA.
The assessment guides our clinical physical therapist to the most dysfunctional non-painful movement pattern, which is then assessed in detail. By addressing the most dysfunctional non-painful pattern, the application of targeted interventions (manual therapy and therapeutic exercise) is not adversely affected by pain.
Injections:Why are ultrasound-guided injections better and more accurate?
When using an injection to deliver treatment into the Carpal Tunnel, it is necessary to be exact and precise. Consider trying to hit a target blindfolded¾you may know the general direction but would not be certain if you have actually hit your target. With live ultrasound imaging, the targeted areas of pain are viewed in real time while the injection is taking place, guiding the needle with pin-point accuracy!
Dr. Isidro and his team are highly trained in ultrasound-guided injections. These procedures are performed in the office, at the time of your visit. Some of the common structures involved in joint pain may be as little as 2-3mm wide and therefore require a high level of precision to be accurate. In addition, when performing an injection, there are also structures that you want to avoid so you don’t knick or damage them on your way into the joint. The ultrasound machine provides live imaging in real time, to safely place a specialized combination of saline and cortisone directed above and below the nerve to “lift off” the ligament and medicate the tendons with anti-inflammatory treatment to reduce swelling. The result is a rapid reduction in symptoms.
When should you see a doctor?
If you have pain in the wrist or forearm for more than two weeks
If your symptoms are getting worse
If you shake your hands out to wake them up during the day or in the morning
If you have numbness or tingling in your hands
If your grip is weak or you drop things
Can an OptimumJoint traditional or regenerative medical procedure help me? To find out if you might be a candidate for an OptimumJoint medical treatment procedure, complete our Optimum Joint Procedure Candidate Form online.