What to Do About Carpal Tunnel Syndrome? Regenerative Medicine Could Prevent the Need for Surgery

Our hands are used in nearly all of our daily functions, from cooking to driving to typing. The nerves of the hand are important for sending signals from the brain 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 except the pinky, so the effects of damage to this particular nerve can be felt throughout the hand. 

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 the carpal tunnel. Carpal tunnel syndrome occurs when the median nerve is pinched in the carpal tunnel. This pinching can cause pain in either 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.

Causes of Carpal Tunnel Syndrome

Wrist pain associated with carpal tunnel syndrome occurs when the median nerve is pinched in the tunnel. Several conditions 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 the 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.

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:

• Numbness
• Tingling
• Pain in the hand, wrist, or up the arm
• Weakness
• Difficulty performing precision tasks

These symptoms will vary from one individual to the next, so it is important to be as detailed 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 diagnosed 3 times more often than men. 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 an 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.

Diagnosis

The first step in diagnosing carpal tunnel syndrome is a conversation with a doctor. This begins with a description of the severity and duration of pain and any other symptoms. History of trauma to the hand or wrist, as well as activity level and family history, are important to discuss as well. 

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.
• 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. 
• 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.

Diagnosing a condition properly will lead to the most effective treatment. With accurate diagnosis, doctors can formulate a treatment plan that will be specific to the patient’s needs.

Non-Surgical Treatment

Treatment plans typically begin with minimally invasive techniques. These include:

• Wearing a splint: splints can provide structure to the wrist and prevent motion that 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 during certain activities such as sleep or typing. Patients should 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 may recommend that patients change certain activities 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 a way that pinches the nerve less.
• Corticosteroid injections: 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 follow the doctor’s directions. 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 mention some surgical options.

Surgical Treatment

The type of surgery that is performed to treat carpal tunnel syndrome is called carpal tunnel release. 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:

• 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 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. Both forms of surgery have fairly high success rates 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. Patients must 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 with an alternative option to surgery. These therapy forms aim to not only manage pain but also treat its source. 

The two forms of regenerative medicine which are offered at CELLAXYS are:

• Cell-Based Therapies: These are more commonly known as stem cell therapies. They involve taking a patient’s own cells or “autologous” tissues, processing them, and reinjecting them into the injury site. They are typically harvested from adipose (fat) tissue, called Minimally Manipulated Adipose Tissue (MMAT) transplant. The doctor may also extract highly concentrated cells from your bone marrow, called Bone Marrow Concentrate (BMAC). Concentrating these cells on a damaged or injured area could help the pain subside.
• Platelet-Rich Plasma (PRP) Therapy: PRP therapy isolates the healing components called plasma from the patient’s own blood cells, concentrates them, and reinjects them into the injury site. Platelets contain 10 Growth Factors to promote the growth of tissues. They also release chemical signals to attract healing cells from the blood and produce a web-like scaffolding for the development of new tissues called fibrin. Increasing the concentration of platelets in an area could lead to a faster healing time.

PRP and cell-based therapies are outpatient procedures, meaning you can go home after the treatment. Cell-based therapies take about 1.5 to 2 hours to complete, while PRP takes about 45 minutes. The doctors use live X-rays and ultrasounds to detect the exact injury location. 

Patients who undergo these therapies will often see results via pain reduction in a few days. The risks associated with regenerative medicine are much lower than with surgery, and the recovery time is much shorter.