Cellaxys

Is Surgery Right for My Carpal Tunnel? Regenerative Therapy Begs to Differ

By November 27, 2019 No Comments

Surgical intervention is no easy task. Between long recovery periods, extensive post-surgical treatment, and the likelihood that results just won’t meet your expectations, there are many things to consider before applying surgical means to any health issue.

Those who suffer from Carpal Tunnel Syndrome (CTS) and its many symptoms have an especially difficult choice to make. Conventional treatment options may provide enough relief from the symptoms, but these can be tedious and insufficient at times. CTS surgery can also drastically reduce the functionality of the limb being operated on and in the end leave a person worse off than where they began.

Whether you are just beginning to weigh your options, or you’ve already run through the gauntlet of treatments and are still unsatisfied with the results, you will want to do some research to determine if surgery is right for your CTS.

Read along if you would like to learn more about the CTS, surgical intervention, and alternative treatments which may apply to your situation. 

Carpal Tunnel, what is it?
Carpal tunnel syndrome is a condition in which one of the major nerves in the hand (median nerve) is pinched or compressed within the wrist. The condition can cause a range of symptoms which appear throughout the arm and hand. These can include:

  • Pain
  • Numbness and tingling
  • Swelling
  • Reduced range of motion
  • Weakness or instability
  • Reduced grip strength

Additionally, these symptoms range from mild to severe and become a chronic problem as a person ages and the tissues within the wrist degenerate.

While many attribute the above symptoms to carpal tunnel syndrome due to its widespread familiarity, the reality is different. According to the American College of Rheumatology, carpal tunnel only “affects 4 – 10 million Americans,” or about 1 in every 35 people. Additionally, “middle-aged to older individuals are more likely to develop the syndrome than younger persons, and females three times more frequently than males.”

While these numbers are high, this doesn’t mean that your particular wrist pain is due to the onset of CTS. There are many conditions with similar symptoms, so a proper diagnosis should be the first step in determining the best treatment method.

How do I know if I have carpal tunnel?
If the above symptoms have become a daily or even weekly problem, this may be an indication of a deeper issue, but it may not exactly be carpal tunnel. The best way to determine what’s causing the symptoms is to reach out to a doctor for a proper diagnosis.

Diagnosing Carpal Tunnel
The consultation procedure for carpal tunnel is simple. Doctors will research the patient’s prior medical history, perform a routine physical examination, use medical imaging for an inside view of the wrist, and finally prepare a treatment plan based on the results and the functional goals of the patient. 

Researching the patient’s medical history is a critical first step in diagnosis CTS. Past injury or issue in the wrist can open up the doors to a world of other soft tissue complications within the wrist which may point doctors in a different direction from carpal tunnel. It is also thought that while carpal tunnel is not genetic, having a close relative with CTS increases the likelihood of inheriting abnormal wrist structures which may also contribute to the presence of CTS-like symptoms.

Once the research phase is complete, doctors will call the patient in for a physical exam. Physical examinations for carpal tunnel are a series of stretches and palpations. Doctors will move the wrist to the outskirts of its reach and apply gentle pressure to various parts of the wrist while doing so. They may compare any pain induced in this process to the other wrist if the issue is isolated to one. 

If the physical examination points to issues with the soft tissues within the wrist or if the symptoms of the CTS flare up due to the exam, doctors will request medical imaging be done on the wrist.

MRIs, CAT scans, and X-rays can all be used to examine the structures within the wrist and guide doctors to a better diagnosis. Using these images they can see if the median nerve is being compressed and if so, which neighboring structures are applying the pressure to the nerve. 

Based on the results of these exams and a discussion with the patient about their functional goals, doctors will prepare a treatment plan. 

For some patients, mobility may be their only issue, others may want to reduce pain or eliminate it completely. Each of these cases will require a different treatment plan, but only the most severe will require surgical intervention.

When is surgery the best option?
If conventional treatment options failed to provide an adequate amount of relief or if your functional goals simply aren’t being met, surgical intervention may seem like the next best option in treating your CTS. 

Physical therapy, medication, and steroidal injections are among the most popular conventional treatment options. While these methods do not exactly treat the source of the issue, they do help relieve the symptoms of it and may even help increase wrist functionality. 

The problem with these treatments is that they are tedious, may come with adverse side effects, and do not provide long-term relief to CTS. 

  • Physical therapy is a constant uphill battle and finding the time to perform the stretches and routines to help manage your CTS symptoms with PT can be difficult. 
  • The potency of medication wanes with time and some medications may be addicting or attack other portions of our bodies in an effort to relieve CTS pain. 
  • Steroidal injections have been shown to drastically impact the health of vital soft tissues and overtime can make symptoms more expressive, increasing pain and reducing functionality or the wrist.

If you’ve attempted these treatments in earnest and haven’t found them to be effective, surgical intervention may seem like a better alternative. In addition to the failure of conventional treatments, other things to consider before applying surgical means to your CTS include:

  • Nerves – in some cases of CTS, nerves are placed under extreme pressure and this can lead to long-term damage. In these cases, surgical intervention is usually the first, rather than last option. Long term nerve damage is much worse than the symptoms of CTS, so treating the issue before it becomes severe is the best option.
  • Other medical issue – some of the symptoms of CTS may flare up due to other health problems such as rheumatoid arthritis, hypothyroidism, or diabetes. Before considering surgery, you may want to see a specialist to determine if treating these issues would help reduce the impact of flare-ups.
  • Pregnancy – pregnancy puts stress on almost every part of the body. In some cases, pregnant women may begin to experience the symptoms of CTS, but this typically goes away shortly after giving birth. If these issues do not stop or begin to develop into a chronic issue, surgical intervention may be necessary. 
  • Symptom expression – if symptoms continue to escalate overtime, usually over a period of 6 months, your CTS may need immediate intervention. Not only do the nerves suffer in these cases, but the soft tissues (cartilage, tendons, muscles) in and around the wrist may begin to experience problems due to the CTS. If no intervention takes place, these issues can amplify existing symptoms and may create other issues throughout the hand and arm.

With all of these factors to consider, there is still one more and it is often the most important to people considering surgery – success rates.

Fortunately for most CTS sufferers, surgery is typically successful and recovery may be quick if nerve damage was minimal. Depending on the health of the median nerve, pain may begin to dissipate within a few weeks, though unfortunately, other symptoms take time and effort to fix or may never go away. 

According to InformedHealth.org, “about 75 to 90 out of 100 people report that their symptoms have improved or that they are symptom-free several years later. But this may have happened without having surgery too.”

There may be a number of reasons why symptoms return or why surgery wasn’t effective in the first place. If surgical intervention failed to provide the desired outcome, some possible explanations include:

  • The median nerve and surrounding tissues may have already sustained enough damage to prevent complete restoration after surgery.
  • The original diagnosis may have been incorrect – CTS symptoms align closely with other wrist issues which can be difficult to distinguish from one another.
  • Surgical errors may have taken place – surrounding tissues may have been cut too deeply or the flexor retinaculum is may not have been cut through completely.

Additionally, InformedHealth.org states that “fewer than 1 out of 100 people have more major complications following surgery. Examples of such complications include a swollen hand or median nerve damage. In these cases trouble moving the hand, pain and numbness might not go away.”

With all of these things to consider, alternative, less invasive treatments may seem like a better option. Thankfully, advancements in regenerative sciences have improved the quality of these treatments, especially as they apply to CTS.

Is regenerative therapy right for me?
Surgery has been thought to be the most effective way to treat the complications from CTS, but the latest research suggests that not only is surgery risky, but may be ineffective compared with less invasive forms of treatment.

The CELLAXYS wrist pain section indicates that:

  • According to a 2014 study, out of 340 patients with nerve injury 16.5% of those injuries were caused by a surgical wrist or ankle procedure
  • In another study, more than 60% of 328 patients reported experiencing wrist pain that interfered with their daily activities 1 year after wrist surgery
  • In 2004, a study of 211 wrist joint arthroscopy patients has been conducted. 5.2% of those patients experienced major and minor complications after the surgery

These numbers may be enough to make anyone reconsider surgical intervention. Thankfully, regenerative therapies offer a much less invasive, much more effective treatment for the symptoms of CTS.

CELLAXYS offers two forms of regenerative therapy for wrist pain associated with carpal tunnel syndrome – platelet rich plasma and stem cell therapy. 

Platelet Rich Plasma Therapy
Platelet rich plasma, or PRP therapy is the process of isolating platelets from a patient’s blood then reinjecting them into the site of an injury to induce healing and amplify the body’s natural healing processes. 

Platelets are one of the body’s natural defenses against injury. When a portion of the body is hurt, the blood rushes platelets to the scene. From there the platelets clump together and send out chemical impulses to attract materials to rebuild damaged tissues.

By mixing the extracted PRP with a number of growth factors and reinjecting them into the wrist, this therapy helps immediately reduce the symptoms of CTS as well as rebuild damaged tissues throughout the wrist. Overtime, not only does the PRP improve the overall function of the wrist, but also helps push back the development of CTS. 

Stem Cell Therapy
Recent advancements in the field of stem cell sciences has led to the development of pseudo-stem cells derived from adult tissues. These pseudo-stem cells are known as mesenchymal stem cells and share many of their healing characteristics. 

By extracting fat or bone marrow from a patient and processing it, doctors create a treatment which is ideal for any issue relating to degeneration, including carpal tunnel syndrome. Similar to PRP, stem cell therapy can help rebuild any broken-down tissues thereby alleviating many of the symptoms of CTS.

The benefit to regenerative therapy over surgical intervention is how minimally invasive they are. Both of these therapies are outpatient procedures which can be done in a single visit and have minimal side-effects which typically take less than 2 weeks to heal. Additionally, most conventional treatment options only help relieve the symptoms of CTS whereas regenerative therapies attack the causal factors as well.

If you would like to learn more about regenerative therapies and how they may be able to help your carpal tunnel syndrome, contact the CELLAXYS offices today in order to set up a consultation. 

Dr. Matthew HC Otten

Dr. Matthew HC Otten

Director of Orthopedic & Orthobiologics
Fellowship-trained & Board Certified in Sports medicine
Director Angiography at Harvard Clinical Research Institute
Michigan Stage University Alumni