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

Experiencing surgical intervention is no easy task. Between possible long recovery periods, extensive post-surgical treatment, and the potential for results that won’t meet your expectations, there are many things to consider before going the surgical route.

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 operated wrist 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.

What Is Carpal Tunnel Syndrome?

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 that occur 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.

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.

Diagnosing Carpal Tunnel

If the above symptoms have become a daily or even weekly problem, this may be an indication of a deeper issue which 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.

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, and 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 issues in the wrist can determine other soft tissue complications within the wrist besides 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.

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 soft tissue problems 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, CT 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.

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 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 (PT) 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 over time can make symptoms more expressive, increasing pain and reducing the functionality of 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 the 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 issues: 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 become chronic, surgical intervention may be necessary.
• Symptom expression: If symptoms continue to escalate over time, usually over a period of 6 months, your CTS may need immediate intervention. Not only do the nerves suffer, 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.

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

Between 75 to 90 people out of 100 indicate that their symptoms have improved or that they are symptom-free many years later. However, this may have happened even if surgery had not been performed.

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 may not have been cut through completely.

Less than 1 in 100 patients experience serious problems as a result of surgery. A swelling hand or injury to the median nerve are examples of such problems. In some circumstances, difficulty moving the hand, as well as discomfort and numbness, may persist.

With all of these things to consider, alternative, less invasive treatments may seem like a better option. Thankfully, advancements in regenerative medicine 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 complications from CTS, but research suggests but it may be ineffective compared with less invasive forms of treatment.

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.

Thankfully, regenerative therapies offer a much less invasive and  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 mesenchymal stem cell transplant procedure.

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. Over time, not only does the PRP improve the overall function of the wrist, but also helps push back the development of CTS.

Mesenchymal Stem Cell Therapy

Recent advancements in the field of cell based therapies, often referred to as “stem cell procedures,” sciences have led to the development of pseudo-stem cells derived from adult tissues. These pseudo-stem cells are known as mesenchymal stem cells.

By extracting adipose (fat) tissue or bone marrow from a patient and processing it, doctors create a treatment that 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.

Both procedures involve transplanting the tissues into to the nerve sheath under live Ultrasound.  This is a complex and exact transplant.  By placing these cells into the nerve sheath, the cells have the opportunity to reduce inflammation and help regenerate healthy tissue.

One of the many benefits of regenerative therapy over surgical intervention is how minimally invasive they are. Both of these therapies are outpatient procedures that can be done in a single visit and have minimal side effects. The recovery time is much quicker as well, typically taking less than 2 weeks to heal.

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.