What is carpal tunnel syndrome?
The carpal tunnel is a part of the wrist surrounded by bones and ligaments. The carpal tunnel is the space where the median nerve and muscles for the hand pass through the wrist. Carpal tunnel syndrome is a condition where the median nerve is compressed or pinched, causing injury to the median nerve.
What are the symptoms of carpal tunnel syndrome?
Carpal tunnel usually occurs gradually and becomes worse over time, especially with continued use of the hands and fingers. The most common symptoms of carpal tunnel include:
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Numbness of the hand or fingers
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Pain in the hand or fingers
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Weakness of the muscles in the hand
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Tingling in the hand or fingers
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Burning sensations in the hand or fingers
What causes carpal tunnel?
No one knows for certain what specifically causes carpal tunnel syndrome. However, there is an association with people who spends a large amount of time typing, especially for work.
How is carpal tunnel diagnosed?
Carpal tunnel syndrome can be diagnosed clinically during a physical exam. There are special exams that are done in the office to determine the likelihood of carpal tunnel being the diagnosis.
A definitive diagnosis is made using the results of a test called EMG (electromyography) and NCS (nerve conduction study). These tests determine the degree of damage to the nerve and muscles of the hand.
What are some of the treatments available for carpal tunnel syndrome?
The standard of care management for carpal tunnel syndrome begins with medications and physical therapy. First line treatment typically begins with over-the-counter pain relievers and anti-inflammatory medications (NSAIDs) coupled with a referral to a physical therapist.
If patient's fail conservative therapy, the next step is usually to try injections of corticosteroids into the wrist. Many patients find these injections to be helpful, however, a number of patients end up having surgery to relieve the compression on the nerve.
What are some alternative treatments for carpal tunnel syndrome?
There are many alternative and non-traditional treatments for carpal tunnel syndrome. Some alternative treatments are more effective than others. Some alternatives include:
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Acupuncture
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Electrical stimulation
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Platelet rich plasma (PRP) or platelet rich fibrin (PRF)
If you have symptoms of carpal tunnel, you should be evaluated by a physician to determine the best course of treatment.
Are alternative treatments such as prolotherapy or PRP/PRF covered by insurance to treat carpal tunnel?
Typically, alternative treatments for conditions such as carpal tunnel syndrome are not covered by insurance. The insurance companies consider these treatments to be investigational. However, there has been at least one study that suggests regenerative treatments such as platelet rich plasma are cost-effective when compared to using steroids.
How do I know if I need surgery for carpal tunnel?
The appropriateness of surgery is a decision you should make with your doctor. There are situations where delaying surgery can result in a greater amount of long-term damage. It is recommended that you discuss your hand pain symptoms with a doctor as soon as possible.
Is it possible to have carpal tunnel in both hands?
Carpal tunnel syndrome usually only affects one hand at a time. However, it is possible to develop carpal tunnel in both hands at once. Patients should undergo a full evaluation to determine if the symptoms are a results of other conditions, such as peripheral neuropathy.
Research on Alternative Treatments for Carpal Tunnel Syndrome
Masiello F, Pati I, Veropalumbo E, Pupella S, Cruciani M, De Angelis V. Ultrasound-guided injection of platelet-rich plasma for tendinopathies: a systematic review and meta-analysis. Blood Transfus. 2022 Oct 17. doi: 10.2450/2022.0087-22. Epub ahead of print. PMID: 36346880.
Babaei-Ghazani A, Moradnia S, Azar M, Forogh B, Ahadi T, Chaibakhsh S, Khodabandeh M, Eftekharsadat B. Ultrasound-guided 5% dextrose prolotherapy versus corticosteroid injection in carpal tunnel syndrome: a randomized, controlled clinical trial. Pain Manag. 2022 Sep;12(6):687-697. doi: 10.2217/pmt-2022-0018. Epub 2022 Jul 18. PMID: 35848821.
Galán V, Iñigo-Dendariarena I, Galán I, Prado R, Padilla S, Anitua E. The Effectiveness of Plasma Rich in Growth Factors (PRGF) in the Treatment of Nerve Compression Syndromes of the Upper Extremity: A Retrospective Observational Clinical Study. J Clin Med. 2022 Aug 16;11(16):4789. doi: 10.3390/jcm11164789. PMID: 36013028; PMCID: PMC9409748.
Klifto KM, Klifto CS, Pidgeon TS, Richard MJ, Ruch DS, Colbert SH. Platelet-Rich Plasma Versus Corticosteroid Injections for the Treatment of Mild-to-Moderate Carpal Tunnel Syndrome: A Markov Cost-Effectiveness Decision Analysis. Hand (N Y). 2022 May 22:15589447221092056. doi: 10.1177/15589447221092056. Epub ahead of print. PMID: 35603672.