Carpal tunnel syndrome is a common wrist condition in the general population that we treat well with an ultrasound carpal tunnel injection. So, do you need it and who benefits from steroid injection for carpal tunnel?
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 the sensation and movement of the thumb and first two fingers, and the ligaments and tendons that comprise the rest of the tunnel. Anything that increases pressure in the tunnel puts pressure on the nerve.
Causes of carpal tunnel syndrome
Certain conditions can increase the risk of carpal tunnel syndrome, such as diabetes, obesity, and a wrist fracture. Also, an underactive thyroid and inflammatory arthritis can lead to more significant pressure on the nerve. Finally, repetitive office-based 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 – the 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 hands. As compression worsens, symptoms occur during 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.
Sometimes, the pain and numbness in the hands can move to the elbow, upper arm, or shoulder – especially in severe cases. However, you should see your doctor to rule out other causes of upper arm or shoulder pain.
Other causes you need to think about
Not all pain and numbness in the hand is due to carpal tunnel syndrome.
You must 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 neck nerve compression, cubital tunnel syndrome in the elbow, wrist arthritis, thumb arthritis, and trigger finger.
Carpal tunnel syndrome treatment
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 and nerve glides may keep the nerves and tendons gliding smoothly.
Moreover, medications such as topical or oral ibuprofen can help reduce pain.
Some alternative therapies may be helpful. For example, Yoga can help strengthen your upper body and grip. In addition, acupuncture has shown mixed effects on carpal tunnel syndrome. Finally, alternative practitioners have suggested supplements such as ALA, papain, and bromelain to reduce tissue swelling.
How effective is a steroid injection for carpal tunnel?
Overall, studies suggest that an ultrasound carpal tunnel injection of cortisone is effective in 80% of cases. Cortisone injected into the carpal tunnel reduces swelling and pressure of the median nerve within the carpal tunnel.
Ultrasound improves the effectiveness of a carpal tunnel injection. Firstly, ultrasound is used to confirm the presence of nerve thickening in the tunnel. Secondly, an ultrasound-guided carpal tunnel injection helps guide the needle to the right spot. We can use a smaller needle to inject the tunnel by using guidance. Finally, there are fewer side effects, as ultrasound allows us to inject cortisone directly into the tunnel rather than into the skin or tendons.
Are there other ultrasound carpal tunnel injection options?
Cortisone injections reduce swelling and pressure on the nerve. However, this reduction in swelling may not last and might be a reason for the failure of a small number of injections. Recently, some doctors have been 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. 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 evidence that PRP injections are effective for carpal tunnel syndrome. Overall, we need more evidence before we can recommend PRP.
What about the surgical release of the carpal tunnel?
A recent review found that surgery was superior to non-surgical treatments overall. Moreover, there was no significant difference between ‘open’ and keyhole surgery.
Other frequently asked questions on carpal tunnel syndrome:
Can carpal tunnel cause neck and shoulder pain?
Yes. If carpal tunnel syndrome is severe, pressure on the nerve can travel up the arm, causing arm, shoulder, and neck pain. However, shoulder and upper arm pain can be due to other causes.
Can lupus cause carpal tunnel syndrome?
Yes. Lupus is an autoimmune condition causing swelling of the tendons in the hand and wrist. This swelling can compress the nerve in the carpal tunnel. Other medical conditions associated with carpal tunnel include diabetes, hypothyroidism, menopause, and pregnancy.
Steroid injection of the carpal tunnel vs surgery: which is better?
Recent evidence suggests that carpal tunnel surgery is more effective in the long term than an ultrasound carpal tunnel injection. However, injections are less risky, cheaper, and easier to perform.
How long do carpal tunnel injections last?
It is hard to know if an ultrasound carpal tunnel injeciton will last. Generally, the duration of action ranges from a few months to a year. Sometimes, an injection can be a cure.
How long does the numbness last after a carpal tunnel injection?
If your doctor uses a local anaesthetic in the ultrasound carpal tunnel injection, you will experience numbness in the hand. This numbness usually lasts up to 4 hours, but can last longer.
Are steroid injections for carpal tunnel safe during pregnancy?
Yes. We know that carpal tunnel syndrome is common during pregnancy due to fluid retention and hormonal changes. A steroid injection is safe during pregnancy, particularly in the second and third trimesters.
Are steroid injections for carpal tunnel painful?
While ultrasound carpal tunnel injections are painful, we can reduce pain by using an optimal technique and ultrasound guidance. Also, you should ensure you see a doctor experienced in ultrasound-guided injections.
Final word from Sportdoctorlondon about ultrasound carpal tunnel injection
Carpal tunnel syndrome is a common cause of wrist or hand pain. We use ultrasound carpal tunnel injections when simple treatments fail. Ultrasound is an excellent tool for carpal tunnel syndrome, as it can confirm the diagnosis and guide a cortisone injection.
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