Carpal Tunnel Syndrome is the most common peripheral nerve entrapement neuropathy which involves compression of the median nerve.
The workdays lost due to carpal tunnel was 27 days according to the 1999 US deptartment of labor statistics. For comparison the average for fractures and amputations were 20 and 18 days respectively the same year.
Patients typically complain of numbness and tingling in the thumb, pointer, middle and sometimes half of the ring finger as well as pain or numbness waking the patient up at night or dropping things more often.
Generally, this is treated by relative rest from provocative activity (typing, writing, etc.), utilizing a night splint, and sometimes an injection with steroid, which interestingly is the least efficacious of all studied injectates including progesterone, local anesthetic, saline, PRP, and dextrose (listed in order of increasing efficacy).
When conservative management fails, traditionally the patient would undergo a surgical procedure to release the transverse carpal ligament which forms the roof of the carpal tunnel to relieve pressure on the median nerve.
Various non-surgical options exist that offer faster recovery and return to work times.
Risk Factors
Female Sex
Pregnancy
Smoking
Alcoholism
Obesity
Advanced Age
Hypothyroidism
Chronic Renal Failure
Rheumatoid Arthritis
Amyloidosis
Sports associated with Carpal Tunnel
Archery
Weight Lifting
Racket Sports
Cycling
Rowing
Rock Climbing
Swimming
Handball
Golf
Wheelchair Athletes
Diagnostic Ultrasonography
Diagnostic ultrasound is a tool that uses sound waves to visualize structures inside the body and can aid in the identification of entrapped nerves as well aid in hydrorelease of entraped nerves.
Electromyography (EMG)
Electromyography is a diagnostic tool that measures muscle response to electrical stimulation which allows for the precise diagnosis and localization of nerve-related problems.
Nerve Hydrodissection/Perineural Therapy
Carpal tunnel syndrome is the most common nerve entrapment. Various other nerves can be entrapped and when conservative measures fail they are often fixed with surgery. Hydrodissection offers a non-surgical approach by utilizing fluid to release the nerve from surrounding tissue structures, reduce pain and restore function.
Perineural therapy involves a utilizing variety of substances that can be placed around irritated nerves that inhibit pro-inflammatory neural pathways (TRPV1, Substance P, calcitonin gene-related peptide) and have neuro-regenerative properties.
Sonex & Guo Technique
Sonex is an insurance-covered minimally-invasive ultrasound-guided procedure performed in a surgical center under local anesthesia that releases the transverse carpal ligament which compression the median nerve causing carpal tunnel syndrome with mean return to work activity in any capacity of 2-3 days.
The Guo Technique is a ultra-minimally invasive ultrasound-guided procedure using thread to release the carpal tunnel and is done in the office setting under local anesthesia. Although it boast, even faster recovery than Sonex, because this technique doesn’t require an incision, it is not covered by insurance.
Learn more about the benefits of minimally-invasive ultrasound-guided techniques at our blog!
If you are suffering from carpal tunnel syndrome and conservative approaches haven’t helped, and are interested in discussing minimally invasive treatment, please call our office (269) 883-6052 or contact us to schedule a consultation.
