Anatomy of the Carpal Tunnel
The carpal tunnel is a portion of the wrist that contains flexor tendons and the median nerve. Flexor tendons are what connect the bones of the hand to the muscles in the forearm. These tendons are a crucial part of hand motion, allowing us to grip and bend our fingers. Carpal tunnel syndrome occurs when the median nerve is being pinched or has been damaged in some way. The median nerve runs from the forearm into the fingers, but does not reach the pinky.
Carpal tunnel syndrome is often associated with sports, as it is sometimes referred to as “tennis elbow’. This condition can occur through a variety of means, however. Repetitive motions of all kinds, from typing to laying bricks, could contribute to carpal tunnel syndrome. These kinds of motions can irritate the flexor tendons and place pressure on the median nerve.
The condition can also occur without repetitive motion – conditions such as diabetes, high blood pressure, hormonal changes, and injury can contribute to carpal tunnel syndrome. Any condition that causes pressure or swelling in the wrist can be associated with carpal tunnel syndrome.
Symptoms of carpal tunnel can include:
- Pain in the forearm, wrist, and fingers
- Tingling in the hand and fingers
- Numbness in the hand and fingers, especially during or after sleep
- Difficulty grabbing items
Diagnosing Carpal Tunnel Syndrome
Experiencing wrist pain can cause complications in daily life. If pain persists and begins to negatively impact activities, it’s time to consult a doctor. Doctors will ask about your family history, history of injury, and current or previous medical conditions. It is important to be honest with doctors about symptoms you are having. Something that may not seem relevant to wrist pain could be indicative of a greater issue.
Doctors will then examine the wrist in an attempt to locate the source of pain. This may include bending and applying a small amount of pressure to the hand, wrist, or forearm. In order to be certain of the condition before making an official diagnosis, doctors will perform certain tests that are designed to indicate median nerve pain or damage. These include:
- Tinel Sign: this test involves a doctor simply tapping the nerve at the wrist to see if there is a reaction in the hand. This is most often felt as a tingling sensation.
- Nerve Conduction Tests: doctors can send a small electrical signal through the median nerve, which is then timed to see how long it takes to reach the hand. A slower time is indicative of nerve pinching or damage.
- Wrist Flexion Test: placing your wrists and fingers together with the backs of each facing one another, and fingers pointing downward, can indicate carpal tunnel. If the patient loses sensation in their hand after 60 seconds, this strongly indicates carpal tunnel syndrome.
- X-Ray: if the median nerve is being pinched by a misalignment of the bone due to previous trauma, doctors may order an X-Ray to see how the bone is aligned.
Each form of diagnosis will be selected using your doctor’s best judgment. It may be necessary to undergo more than one test, especially if you have other conditions occurring such as arthritis or diabetes.
Treating Carpal Tunnel Syndrome
Once a diagnosis has been made, doctors can begin to formulate a treatment plan. Each treatment plan will be adjusted to meet each patient’s specific needs. Some of the options for managing symptoms include:
- Medication: some over-the-counter anti-inflammatory drugs such as Ibuprofen or Naproxen can relieve pain, making it easier to complete tasks that would otherwise be difficult.
- Stabilize the Wrist: using a device for support such as a brace or wrap can reduce pinching on the median nerve by restricting motion in the hand. This may be recommended especially during the activities that cause pain, and during sleep.
- Activity Adjustment: if carpal tunnel syndrome is occurring due to repetitive motions, doctors may recommend stopping the activity. If this is not possible, they may suggest that you take more breaks or change the way you do it.
- Corticosteroid Injections: these injections contain cortisol, a powerful anti-inflammatory hormone. These injections may relieve pressure on the median nerve, but they have been proven to damage soft tissue over time. It is important to closely monitor these injections to avoid tissue damage.
- Surgery: Carpal Tunnel Release surgery may become an option if symptoms persist, even after weeks of conventional treatment. This surgery is seen as a last resort to relieve pain associated with carpal tunnel syndrome. There are two types of surgery that can be done:
- Open: this surgery begins with an incision on the palm of the hand, exposing the transverse carpal ligament (the top portion of the carpal tunnel). The ligament is then cut to relieve pressure from the nerve.
- Endoscopic: this type of surgery uses a small camera to guide the surgeon to the transverse carpal ligament, which is then cut using another small tool. The incisions are generally smaller for this type of surgery, and there may be one or two incisions.
Making the Decision
Deciding to undergo surgery is an important process. It is important to maintain an open dialog with doctors and surgeons, and ask questions as they may arise. Many factors may influence a patient’s decision to undergo surgery, including money, taking time off of work, extent of daily disruption, and support system.
Recovery can be difficult, but doctors and surgeons are prepared to help the process. Knowing what to expect before, during, and after surgery can be extremely beneficial to a patient. Having clear expectations of what will happen on the operating table can ease a lot of stress and anxiety that may be surrounding the decision. Understanding the risks of surgery is important going in – these include infection, blood clots, or a reaction to anesthesia – though they may be more risks that are important to discuss with professionals.
Carpal Tunnel Release Surgery Timeline
Both types of carpal tunnel surgery follow a similar timeline for recovery, as their essential goal is the same: cut the transverse carpal ligament. The recovery process focuses mainly on strengthening the wrist and allowing the space around the median nerve to heal. Recovery timelines can vary from patient to patient, but generally follow this timeline:
- Preparing for Surgery: once the decision has been made, there are several steps you may need to take in order to ensure that the surgery goes smoothly. This may include blood tests, stopping smoking, arranging a ride home, and taking time off of work. Surgeons will probably ask that you stop eating or drinking for a certain amount of time before the operation. Make sure that you are as informed as you are comfortable about the operation before going in.
- The Operation: anesthesia is commonly used for this procedure, though it may be used in different forms. There is general anesthesia, which induces sleep and is generally not used for carpal tunnel release unless it is necessary for the patient. Most surgeons will choose to use local or regional anesthetic for this surgery, as it is a minor operation. These forms of anesthesia are applied to a smaller area, such as the arm or wrist. Patients may be awake during the procedure when local or regional anesthesia is used. Some surgeons will include medication that induces sleep to make the patient more comfortable.
- First Few Hours after Surgery: carpal tunnel release is most often an outpatient procedure, meaning that the patient is allowed to leave the hospital once it is complete. In some rare cases, patients stay overnight – this is more likely to occur if complications arise. Due to medication and the nature of the surgery, you will be asked to arrange a ride home. The wrist will be immobilized in a splint or bandages.
- One to Two Weeks After Surgery: most splints and bandages are removed within the first two weeks. There will likely be pain in the wrist at this time. It is important to move fingers around as much as possible during this time so that they don’t become stiff. Elevation of the wrist, especially while sleeping, might be recommended so that swelling does not occur. Once the splint or bandages are removed, physical therapy begins. The goals of physical therapy are to strengthen the wrist and improve circulation in the area. Improved circulation can speed up the healing process by sending healing properties in the blood to the wrist.
- One Month After Surgery: doctors may have suggested that use of a splint or brace continue after the first two weeks. This may be reduced to certain activities. Physical therapy should continue as recommended.
- Three Months After Surgery: pain should be significantly reduced or gone at this time. It is more likely that the injury will be healed within three months if physical therapy has been a part of the recovery process. If pain or other symptoms persist after three months, consult your doctor.
How Regenerative Medicine Can Help
The field of regenerative medicine seeks to use a patient’s own naturally occurring cells to enhance the healing process. CELLAXYS offers two types of regenerative therapy:
- Stem Cell Therapy: this form of therapy begins with taking a patient’s stem cells, which are taken via needle using blood cells, fat cells, or bone marrow. The cells are then processed to a more dense concentration, then reinjected into the injury or surgery site. Stem cells contain healing properties that the body already uses when an injury or damage occurs. Placing a concentrated stem cell solution into a part of the body that is healing could help the wrist heal faster.
- Platelet-Rich Plasma Therapy: this form of therapy begins with a simple blood draw. The patient’s blood is then placed in a centrifuge to separate platelets in the blood from other components. The platelets are then injected into the injury or surgery site, similarly to stem cell therapy. Platelets contain proteins and growth factors that the body uses naturally to heal damage. Increasing the amount of these properties where damage has occurred could help the injury heal faster.
Stem cell and PRP therapy are outpatient procedures. Patients typically see results within a matter of days, some even reporting pain relief within hours of receiving the injection. These therapies can be used as a part of the carpal tunnel release recovery, or they can be used to prevent the need for surgery.
Regenerative medicine practices have yielded promising results for chronic pain conditions such as carpal tunnel syndrome. The pinched nerve may be relieved after an injection, which could lead to a decrease in symptoms.
Carpal tunnel syndrome is a common condition and therefore well understood. Doctors and surgeons can provide the tools necessary to manage symptoms. If initial treatment methods do not work after several months, surgery may be an option. It is important to be well-informed about the surgery before going in to put the mind at ease. There may be another option, or at least one that could be coupled with surgery – regenerative medicine offers pain relief before or after surgery. Once pain subsides, regular activities can resume as they did before the condition arose.