Carpal tunnel syndrome is a common wrist condition in the general population that we treat well with a carpal tunnel injection. So, do you need a carpal tunnel injection?

What makes up the carpal tunnel? 

The carpal tunnel is a narrow passageway on the palmar side of the wrist. The tunnel contains the median nerve, which controls sensation and movement of the thumb and first two fingers,  and ligaments and tendons that make up the rest of the tunnel. Anything that causes increased pressure in the tunnel causes pressure on the nerve.

Causes of carpal tunnel syndrome

Certain conditions can increase the risk of carpal tunnel syndromes such as diabetes, obesity, and a wrist break. Also, underactive thyroid and inflammatory arthritis can lead to greater pressure on the nerve. Finally, repetitive activity such as office-based work or manual labour can increase the risk.

Symptoms of carpal tunnel syndrome

Generally, the most common symptoms are altered sensations in the hands or fingers. Usually, this altered sensation occurs primarily in the areas supplied by the median nerve – thumb, index, and middle fingers. However, sometimes people say that their whole hand becomes numb.

Early on, symptoms occur only at night and are better with shaking the hand. As compression gets worse, symptoms occur with activities during the day. Also, the altered sensation is accompanied by pain and weakness. You may find yourself having problems opening jar lids and frequently dropping objects. Finally, toward the more severe end of the spectrum, you may see wasting of the muscles supplied by the median nerve – usually in the palm toward the base of the thumb.

Other causes you need to think about

Not all numbness in the hand is due to carpal tunnel syndrome. You need to see a doctor to confirm the diagnosis and rule out other conditions. Generally, your doctor will perform a clinical examination to test the nerves in your hand. Also, you may need an ultrasound, nerve studies or other tests to confirm the diagnosis. Some conditions that resemble carpal tunnel syndrome include nerve pinching in the neck, cubital tunnel syndrome in the elbow, wrist arthritis, thumb arthritis, and trigger finger.

What treatments are available for carpal tunnel syndrome? 

Generally, simple treatments such as wrist stretching and wearing a wrist splint at night can help relieve pressure on the nerve. Also, referral to a physiotherapist for exercises is helpful. Generally, tendon glides and nerve glides may keep the nerves and tendons gliding smoothly. Moreover, medication such as topical or oral ibuprofen can improve pain.

Some alternative therapies may be helpful. For example, Yoga can help strengthen your upper body and grip. Acupuncture has shown mixed effects with carpal tunnel syndrome. Finally, supplements such as ALA, papain, and bromelain have been suggested by alternative practitioners to reduce tissue swelling.

How effective is a carpal tunnel injection? 

Overall, studies suggest that a carpal tunnel injection of cortisone is effective in 80% of cases. Ultrasound makes a carpal tunnel injection more effective. Firstly, ultrasound is used to confirm the thickening of the nerve in the tunnel. Secondly, it helps to guide the needle in the right spot. By using guidance, we can use a smaller needle to inject the tunnel. Finally, there are fewer side effects as an ultrasound allows us to inject cortisone correctly into the tunnel rather than the skin or tendons. When injections are effective, they can be safely repeated up to three times to increase the chances of a complete cure.

The other benefit of injections is that a positive effect confirms the diagnosis.

ultrasound-guided injection into carpal tunnel

Are there other injection options? 

Cortisone injections reduce swelling and pressure of the nerve. However, this reduction in swelling may not last and might be a reason for a failure of a small number of injections.  Recently, some doctors are performing an advanced procedure to free up the nerve from scar tissue in the carpal tunnel. This procedure is called ‘hydroneurolysis’ and aims to release the nerve from the thickened wrist ligament. Overall, this advanced injection mimics a surgical carpal tunnel release without the associated cost or complications.  Early results are encouraging.

Some doctors are using platelet-rich plasma for carpal tunnel syndrome. Although platelet-rich plasma is anti-inflammatory, there is little evdeicen that injections of PRP are effective for carpal tunnel syndrome. Overall, we need more evidence before we could recommend PRP.

What about surgical release of carpal tunnel? 

Overall, surgery involving cutting the top of the carpal tunnel to release the nerve is effective at improving symptoms. A recent review found that surgery was better overall than non-surgical treatments. Moreover, there was no big difference between ‘open’ and keyhole surgery.

Final word from Sportdoctorlondon about carpal tunnel injection

Generally, carpal tunnel syndrome is a common cause of pain in the wrist or hand. We use injections when simple treatments fail. Ultrasound is fantastic for carpal tunnel syndrome as it can confirm a diagnosis and help guide a cortisone injection. If all non-surgical treatments fail, then surgery is a good option.

Other elbow and hand conditions:

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

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