Our hands are used in almost all of our daily functions, from cooking to driving to typing. The nerves of the hand are important for sending signals from the brain all the way to our fingertips. When these nerves become damaged or pinched, the resulting pain can be difficult to bear.
Carpal tunnel syndrome occurs when the median nerve is pinched. This nerve is in charge of the signals sent to all of our fingers beside the pinky, so the effects of damage to this particular nerve can be felt all throughout the hand and significantly impact day-to-day activities. Wrist pain has the potential to disrupt someone’s life.
This article will discuss the anatomy of the hand briefly, potential causes of carpal tunnel syndrome, the signs and symptoms, diagnostic methods, non-surgical treatments, surgery, and alternative therapies which may provide new hope to patients faced with this type of pain.
Anatomy of the Hand
The main nerve that controls a lot of hand function is called the median nerve. It reaches up to the thumb, index finger, middle finger, and ring finger. The median nerve allows the hand and fingers to perceive touch, among other functions. To get to the hand, the median nerve passes through what is called the carpal tunnel. Carpal tunnel syndrome occurs when the median nerve is pinched in the carpal tunnel. This pinching can cause pain in any, or all, of the fingers listed above.
The carpal tunnel also contains some tendons, fibrous tissue that connects muscle to bone. The “tunnel” is made primarily of bones, but the top part is made of a ligament. Ligaments serve to connect bone to other bone or cartilage. Tendons and ligaments serve an important role in hand structure, providing the joints with flexibility and mobility.
The reason why this nerve may be pinched will vary from patient to patient.
Causes of Carpal Tunnel Syndrome
Pain associated with carpal tunnel syndrome occurs when the median nerve is pinched in the tunnel. There are several conditions that may exacerbate the condition or even cause this to occur. These conditions are:
- Diabetes: nerve damage may occur in patients who are suffering from diabetes, which could lead to damage to the median nerve.
- Arthritis: patients with arthritis are facing a form of degeneration in their bodies. This degeneration effectively reshapes bone and joint structure and may impact the carpal tunnel.
- Pregnancy or Menopause: hormonal changes can lead to swelling in the wrist, which may pinch the median nerve.
- Injury to the Wrist: experiencing trauma in the wrist may change the structure of the carpal tunnel and the efficacy of the surrounding bones, tendons, or ligaments.
- High Blood Pressure: a known contributing factor to carpal tunnel syndrome.
Carpal tunnel syndrome is most commonly associated with repetitive motion, but new studies suggest that this may not be the only cause. There is a correlation between repetitive motion and carpal tunnel syndrome, but there are many other potential contributing factors to the pain.
Signs and Symptoms
The median nerve allows fingers and parts of the hand to feel sensation, constantly sending and receiving signals from the brain. For this reason, the symptoms can vary greatly. The most common symptoms are:
- Pain in the hand, wrist, or up the arm
- Sensation of weakness
- Trouble creating a strong grip or dropping objects often
- Difficulty performing precision tasks
These symptoms will vary from one individual to the next, so it is important to be specific and as informative as possible when meeting with a doctor about the symptoms.
Carpal tunnel syndrome can occur to anyone at any time. People who have had issues with arthritis are at higher risk, meaning that the senior population is at an increased risk of developing carpal tunnel syndrome. Women are more often diagnosed than men, and people who have jobs that require repetitive motion such as typing or handling power tools that vibrate are at an increased risk. People who have suffered injury to the wrist or hand are also at an increased risk, as their bones, ligaments, and tendons sometimes heal in a way that pinches the median nerve.
The first step in diagnosing carpal tunnel syndrome is a conversation with a doctor. This begins with a description of the location, severity, and duration of pain or other symptoms. History of trauma to the hand or wrist, as well as family history and activity level, are important to discuss as well. In some cases, doctors can diagnose carpal tunnel syndrome after having this discussion. In other cases, doctors will perform a series of tests and diagnostic methods to ensure a proper diagnosis. These tests include:
- Tinel’s Sign: doctors will tap the affected nerve to see if this causes pain.
- Phalen Test: also sometimes referred to as a wrist flexion test, patients place their arms and wrists in a certain way. The position of the arms and hands can indicate carpal tunnel if the patient experiences a tingling sensation in the affected hand, or if the hand begins to fall asleep.
- Two-Point Discrimination Test: this form of testing involves determining if a patient can experience sensation in two places at once. The median nerve is involved with sensation in the hand, so determining what sensations may be felt can give doctors a better idea of what is going on under the surface.
- Nerve Conduction Tests: using varying methods, doctors can test how quickly a signal is sent into the hand. Damage to the median nerve will result in the signal being sent slower, so this form of testing can indicate the presence of a carpal tunnel quite accurately.
- X-Rays: in some cases, doctors will want to look at the bone surrounding an injury. Deformities or abnormalities in the bone can cause pinching of the median nerve. Getting a clear picture of the structure can provide doctors clues as to what is happening to cause pain.
Diagnosing a condition properly will lead to the most effective treatment. With accurate diagnosis, doctors are able to formulate a treatment plan that will be specific to the patient and as beneficial to them as possible.
Treatment plans typically begin with minimally invasive techniques. These include:
- Wearing a splint: splints can provide structure to the wrist and prevent motion which causes pain. If the nerve is being pinched less, it can begin to heal. It may be recommended that a patient wear a splint all of the time, or only during certain activities such as sleep or typing. It is generally recommended that patients wear a splint during activities that exacerbate symptoms.
- Anti-inflammatory Measures: taking over-the-counter NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as Ibuprofen can reduce inflammation, which can help with symptoms. Some doctors may also recommend that a patient apply ice to the affected area to provide similar benefits.
- Adjustment of Certain Activities: if specific activities are contributing to pain and discomfort, doctors will sometimes recommend that patients change certain aspects of it to relieve tension in the carpal tunnel. This may include sleeping in a different position, or adjusting a patient’s desk space so that they can type in such a way that pinches the nerve less.
- Corticosteroid Injections: whereas NSAIDS delivers a small number of anti-inflammatory properties to the pain area, corticosteroid injections deliver a high dose of anti-inflammatory cortisol directly into the pain site. This can relieve pain symptoms in the short-term, but has been proven to damage nerves over time and should, therefore, be closely monitored.
When going through these treatment options, it is important to do as the doctor orders for the amount of time which they recommend. Certain treatments, such as wearing a brace, will be less effective if the patient does not follow through. The ultimate goal of treatment is to allow the patient to live a more comfortable life.
The pinching of the median nerve that is characteristic of carpal tunnel syndrome can sometimes heal itself with these methods. When these treatments fail to relieve pain, however, doctors will open up a discussion about surgical options.
The type of surgery which is performed to treat carpal tunnel syndrome is called Carpal Tunnel Release surgery. The main goal of the surgery is to break the tendon in the carpal tunnel, allowing the median nerve to have more space and less pressure on it.
Pain caused by carpal tunnel syndrome is associated with increased pressure in the carpal tunnel, so breaking the tendon that keeps the tunnel “closed” could relieve stress on the nerve. There are two forms of this surgery which a patient may become aware of:
- Endoscopy: this type of surgery is minimally invasive. It uses very small tools to break the tendon without opening the whole wrist. It typically involves only one or two small incisions and takes a short amount of time to perform.
- Open Surgery: open surgery also takes a short amount of time to perform. Surgeons make one incision in the palm of the hand to get to the tendon above the median nerve, where it is then cut to make space for the median nerve.
These surgeries are performed using anesthesia which can be regional, local, or general. The surgeon will determine which form of anesthesia is best for each patient individually. Both forms of surgery have a fairly high success rate and a low risk of complication. Some risks of surgery include complications with anesthesia, infection, blood clots, and stroke, among others.
Deciding whether a patient needs to undergo surgery for chronic pain is a difficult decision for doctors and patients alike. It is important that patients consider all of the possible treatment options, as surgery may not always be necessary.
How Regenerative Medicine Can Help and May Prevent the Need for Surgery?
The emerging field of regenerative medicine and therapy may provide chronic pain sufferers an alternative option to surgery. The goal of these forms of therapy is to not only manage pain but possibly treat it at the source. The two forms of regenerative medicine which are offered at CELLAXYS are:
- Stem Cell Therapy: this form of therapy involves taking a patient’s own stem cells. They are typically harvested from fat cells (adipose tissue), blood cells, or bone marrow. The stem cells are then processed and reinjected into the source of pain. Stem cells contain healing properties that are already used in many of the body’s natural processes. Placing them into an area that is damaged or injured could help the pain subside by helping the damage heal.
- Platelet-Rich Plasma (PRP) Therapy: this form of therapy takes a patient’s own blood cells, harvested using a simple blood draw. The blood is then placed into a centrifuge to separate the platelets from the plasma in the blood. Platelets contain proteins and healing factors which the body uses in its own healing processes. The concentrated platelets are then injected into the source of pain, similar to stem cell therapy. Increasing the concentration of healing properties in an area could lead to a faster healing time.
Both of these forms of therapy are performed as outpatient procedures and typically take less than two hours to complete. Patients who undergo these therapies will often see results via pain reduction in a matter of hours or days.
The risks associated with regenerative medicine are much lower than that of surgery, and the recovery time is much shorter.
Carpal tunnel syndrome is a form of chronic pain, and regenerative medicine has shown promising results in treating chronic pain. The pinching of the nerve could be relieved with this form of therapy, and subsequent numbness, weakness, tingling, and many other symptoms may subside with treatment.
Carpal tunnel syndrome, which is caused by pinching of the median nerve, is a common ailment. Getting a proper diagnosis is crucial to eventually receive proper treatment. It is important that patients be transparent and honest with their doctors so that they can recommend a treatment process that is as beneficial as possible to the patient.
Surgical options may seem overwhelming, so individuals who are facing the option of surgery should consider all of the possible treatments that are on the market.
Regenerative medicine offers new hope for treating chronic pain, possibly prolonging, and even eliminating the need for surgery. Even a small surgery such as carpal tunnel release can be life-altering during the recovery process. In order to live a life that is pain-free and enjoyable, patients could look to regenerative medicine for new hope.