Carpal tunnel syndrome, what is it?

The carpal tunnel is located underneath the wrist crease overlying the wrist joint. The carpal tunnel is a protective tunnel of bone and has a ligament overlying the anatomical structures (Fig. 1). The transverse ligament is a thick ligament very much like a cable tie and keeps all the structures in place.

Carpal tunel graphic

Carpal tunnel syndrome

Many critical structures are tightly packed together within a small tunnel. The carpal tunnel syndrome can be caused by the tunnel becoming strained which can affect the structures running in the carpal tunnel. Nerve tissue is sensitive to small changes in pressure. This can cause nerve irritation and cause symptoms of carpal tunnel syndrome. The main symptoms are pain and numbness in the distribution of the median nerve (see Fig. 2). Compression of the nerve can also cause significant weakness of the musculature if more advanced.

If left untreated compression of the median nerve can cause lasting nerve damage. This can lead to permanent weakness and numbness and pain in the hand. It is therefore important to diagnose this problem early on and to treat it promptly.

We be discussing treatment options and pose the question what conservative treatments are helpful and especially injection therapy. So we can hopefully answer the question in the title of this article: Carpal tunnel injection- is it helpful?

 

Causes of carpal tunnel syndrome

There is still a lot unknown about carpal tunnel syndrome. We know that there are several factors that play a role in developing carpal tunnel syndrome.Physical repetitive activity could be a factor. There are other factors such as diabetes, hormonal changes such as during pregnancy and an underactive thyroid. These can all be contributing factors. A direct injury to the wrist can also cause damage to the median nerve the wrist joint. This in turn can also cause problems with the median nerve.

Treatment of carpal tunnel syndrome

The correct treatment of carpal tunnel syndrome depends on the accuracy of the diagnosis. The most important way to evaluate the carpal tunnel is simply by doing a thorough physical assessment. The Sonoscope ultrasound guided injection clinic has experts with many years of experience. They have successfully managed many hundreds of people with carpal tunnel syndrome.

The use of diagnostic ultrasound provides another level of information and often confirms the diagnosis made by physical examination. Ultrasoujd can detect nerve caliber changes along the nerve path which is commonly found in Carpal tunnel syndrome and can help to confirm the diagnosis.

If left untreated compression of the median nerve can cause lasting nerve damage. This can lead to permanent weakness and numbness and pain in the hand. It is therefore important to diagnose this problem early on and to treat it promptly.

Ultrasound guided injection

Carpal tunnel injection- is it helpful?

We would always advocate for this procedure to be done under ultrasound guidance. This will improve the accuracy of the procedure as well as the safety. Only those with a high level of diagnostic ultrasound and ultrasound guided injection expertise and who perform a significant number of these injections regularly should be performing ultrasound-guided injection for carpal tunnel syndrome as it is technically demanding.

Evidence:

Eslamian (et al, 2017) comparing both landmark guided with ultrasound guided injections concludes: that the evidence Both US-guided and LM-guided steroid injections were effective in reducing the symptoms, improving the function and electrodiagnostic findings of CTS. Although there was better symptomatic improvement with US-guided injections.

Safety:

In the hands of a highly trained expert in diagnostic ultrasound and ultrasound guided procedures the needle tip can be accurately monitored and steered to inject in the exact accurate location. This will reduce the risk of inadvertent nerve or vascular injury.

Comfort:

Accuracy and needle monitoring will also result in significantly less discomfort as it will allow the operator to avoid as much as possible pain sensitive structures.

 

Carpal tunnel decompression surgery: 

If the numbness and pain and or weakness don’t improve with other treatments, then surgery might be required. The surgery, known as carpal tunnel release or decompression surgery relieves pain by reducing the pressure on the median nerve. 

References:

Recovery from the surgery is usually less than a month, although it may take longer to get all the feeling back in your hand, especially if you’ve had the condition for a long time. 

Eslamian, F., Eftekharsadat, B., Babaei-Ghazani, A., Jahanjoo, F. and Zeinali, M., 2017. A randomized prospective comparison of ultrasound-guided and landmark-guided steroid injections for carpal tunnel syndrome. Journal of Clinical Neurophysiology34(2), pp.107-113.

References:

Eslamian, F., Eftekharsadat, B., Babaei-Ghazani, A., Jahanjoo, F. and Zeinali, M., 2017. A randomized prospective comparison of ultrasound-guided and landmark-guided steroid injections for carpal tunnel syndrome. Journal of Clinical Neurophysiology34(2), pp.107-113.