CARPAL TUNNEL INJECTION

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is a common condition that causes numbness, tingling, and pain in the hand and forearm. The condition occurs when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist. 

In most patients, carpal tunnel syndrome gets worse over time. If untreated for too long, it can lead to permanent dysfunction of the hand, including loss of sensation in the fingers and weakness. For this reason, it is important to diagnose and treat carpal tunnel syndrome promptly.

Anatomy:

The carpal tunnel is a narrow, rigid passageway in the wrist, approximately one inch wide. Its floor and sides are composed of small wrist bones known as carpal bones, while its roof is formed by a strong band of connective tissue called the transverse carpal ligament. Due to the rigidity of these structures, the carpal tunnel has limited capacity to expand.

The median nerve is a crucial nerve in the hand, originating from nerve roots in the neck. These roots converge to form a single nerve that travels down the upper arm, crosses the elbow, and extends into the forearm. It then passes through the carpal tunnel at the wrist, continuing to the hand and fingers. As it reaches the palm, the median nerve branches into several smaller nerves, providing sensation to the thumb, index finger, middle finger, and half of the ring finger (the side closest to the thumb). Additionally, the median nerve controls the muscles around the base of the thumb.

Causes:

Most cases of carpal tunnel syndrome result from a combination of factors. Research indicates that women and older individuals are at higher risk of developing this condition.

Other factors that increase the risk of carpal tunnel syndrome include:

  1. Genetics: Hereditary factors play a significant role. Some individuals may naturally have a smaller carpal tunnel or anatomical differences that reduce space for the nerve, and these traits can be inherited.
  2. Repetitive Hand Use: Performing repetitive hand and wrist movements or activities over a prolonged period can strain the wrist tendons, leading to inflammation that compresses the nerve.
  3. Hand and Wrist Position: Activities involving prolonged extreme flexion or extension of the hand and wrist can also increase pressure on the nerve.
  4. Pregnancy: Hormonal changes during pregnancy can cause fluid retention and swelling, which can put pressure on the nerve.
  5. Health Conditions: Conditions such as diabetes, rheumatoid arthritis, and thyroid disorders are associated with an increased risk of developing carpal tunnel syndrome.

Symptoms:

Symptoms of carpal tunnel syndrome can include:

– Numbness, Tingling, Burning, and Pain: Typically felt in the thumb, index, middle, and ring fingers. These sensations often wake individuals up at night.
Occasional Shock-like Sensations: Radiating to the thumb, index, middle, and ring fingers.
– Pain or Tingling: Sometimes extending up the forearm toward the shoulder.
Weakness and Clumsiness: Difficulty performing delicate movements like fastening buttons.
– Dropping Things: Due to weakness, numbness, or decreased awareness of hand position.

Symptoms usually develop gradually without a specific injury. Initially, they may come and go, but as the condition progresses, they may become more frequent or persistent.

Nighttime symptoms are common, often caused by sleeping with wrists bent. During the day, symptoms may worsen when holding objects for extended periods with the wrist bent forward or backward, such as when using a phone, driving, or reading.

Many patients find relief by moving or shaking their hands.

Physical Examination

During your evaluation, your clinician will discuss your overall health and medical history and inquire about your symptoms.

They will conduct a thorough examination of your hand and wrist, including several physical tests. These may involve:
– Testing Tinel’s Sign: Your doctor will press down or tap along the median nerve on the palm side of your wrist to check for any tingling sensations that radiate into your fingers.
– Wrist Flexion Test: They will bend your wrists and hold them in a flexed position to assess for numbness or tingling sensations in your hands.
– Sensitivity Test: Using a specialized instrument, your doctor will lightly touch your fingertips and hands while your eyes are closed to evaluate sensitivity.
Assessing Muscle Strength: They will check for weakness in the muscles around the base of your thumb, which are controlled by the median nerve.
– Checking for Muscle Atrophy: In severe cases, your clinician may look for shrinkage (atrophy) in these muscles, which can indicate prolonged nerve compression.

This comprehensive examination helps your clinician diagnose carpal tunnel syndrome and determine the most appropriate course of treatment.

Diagnostic Tests:

In some cases, additional tests may be necessary to diagnose and assess carpal tunnel syndrome.

Electrodiagnostic Tests: Your clinician may recommend these tests to evaluate how well your median nerve functions and to determine if there is excessive pressure on the nerve. These tests can also help in:

– Assessing the severity of carpal tunnel syndrome.
– Identifying compression of the nerve in other areas.
– Checking for involvement of other nerves.
– Detecting underlying conditions like neuropathy in addition to carpal tunnel syndrome.

Electrodiagnostic tests may include:

Nerve Conduction Studies (NCS): These tests measure the speed and strength of signals traveling through the nerves of your hand and arm. They can indicate if the nerve is functioning properly and help guide treatment decisions. 
Electromyogram (EMG): An EMG assesses the electrical activity in muscles to detect any nerve or muscle damage.
– Ultrasound: High-frequency sound waves create images of bone and tissue. Your doctor may use ultrasound to examine the median nerve in your wrist for signs of compression.
-X-rays: These provide detailed images of bones. If you experience limited wrist movement or wrist pain, X-rays may be ordered to rule out other potential causes such as arthritis, ligament injuries, or fractures.
-Magnetic Resonance Imaging (MRI) Scans: MRI scans offer detailed images of soft tissues. They may be recommended to investigate alternative causes of symptoms or to identify abnormalities affecting the median nerve, such as tumors or scar tissue from injuries.

These diagnostic tests are essential for confirming carpal tunnel syndrome and determining the most effective treatment approach.

Treatment

Carpal tunnel syndrome typically progresses gradually, and without intervention, it tends to worsen over time. Therefore, early evaluation and diagnosis by your doctor are crucial. In the initial stages, it may be possible to slow down or halt the disease’s progression.

Non-Surgical Treatment

If diagnosed early and treated promptly, many individuals with carpal tunnel syndrome can find relief from symptoms without undergoing surgery. If there is uncertainty about the diagnosis or if symptoms are mild, your doctor will first recommend nonsurgical approaches.

Nonsurgical treatments may include:

Bracing or Splinting: Wearing a brace or splint at night prevents bending of the wrist during sleep, maintaining it in a straight or neutral position to alleviate pressure on the carpal tunnel nerve. Using a splint during activities that worsen symptoms can also be beneficial.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Medications like ibuprofen and naproxen reduce pain and inflammation, providing relief from symptoms.
– Activity Changes: Symptoms often arise from prolonged hand and wrist positions, especially when the wrist is flexed or extended. Modifying activities that aggravate symptoms, whether at work or during recreational pursuits, can help halt or slow the progression of the condition. This may involve adjustments to your workplace or workstation setup.
Nerve Gliding Exercises: Some patients benefit from exercises that promote freer movement of the median nerve within the carpal tunnel, as recommended by a doctor or therapist.
Steroid Injections: Corticosteroid injections into the carpal tunnel reduce inflammation and relieve painful symptoms temporarily. They may also aid in diagnosing carpal tunnel syndrome.
Platelet Rich Plasma (PRP) Injections: Derived from a patient’s own blood, PRP injections are used to treat various musculoskeletal conditions, but their long-term benefit for carpal tunnel syndrome is uncertain.

Surgical Treatment:

If nonsurgical options fail to provide relief:

Indications for Surgery: Surgery may be recommended based on the severity of symptoms, physical exam findings, response to nonsurgical treatment, and diagnostic test results. Long-standing cases with constant numbness and muscle wasting in the thumb may require surgery to prevent irreversible damage.

Ultrasound-Guided Cortisone Injections at Joint Injections:

Ultrasound-guided cortisone injections are an effective and precise treatment for carpal tunnel syndrome. At Joint Injections, we use ultrasound imaging technique to guide the needle into the carpal tunnel, ensuring accurate delivery of the medication.

Benefits of Ultrasound-Guided Cortisone Injections:

Precision: Ultrasound guidance allows for exact placement of the cortisone injection for carpal tunnel. This ensures the medication is delivered directly to the area of inflammation, enhancing its effectiveness.
Efficacy: Precise delivery can lead to better pain relief and improved function in the affected hand and wrist.
Safety: Ultrasound imaging helps avoid damage to surrounding tissues and structures, reducing the risk of complications.

Why Choose Ultrasound-Guided Cortisone Injections at Joint Injections?

At Joint Injections, we specialise in providing high-quality, ultrasound-guided injections for carpal tunnel syndrome. Our experienced team ensures that each carpal tunnel injection is administered with the utmost precision and care. Here’s why you should choose Joint Injections:

– Expertise: Our clinicians have extensive experience in performing ultrasound-guided injections, ensuring the best possible outcomes for our patients.
– Advanced Technology: We use the latest ultrasound equipment to provide accurate and effective treatments.
– Patient-Centred Care: Your comfort and safety are our top priorities. We offer personalised care tailored to your specific needs and preferences.
– Comprehensive Approach: We provide a thorough assessment and a range of treatment options to ensure you receive the most appropriate care for your condition.

At Joint Injections, we are dedicated to providing the best possible care to help you manage your carpal tunnel syndrome and improve your quality of life. Our expertise in ultrasound-guided injections ensures that you receive the most accurate and effective treatment.

We understand that each patient is unique, and we are committed to offering personalised treatment plans that meet your specific needs. Our goal is to help you achieve relief from your symptoms and regain full function of your hand and wrist.

If you are experiencing symptoms of carpal tunnel syndrome, don’t hesitate to contact Joint Injections. Our team of specialists is ready to help you find the most suitable treatment options and support you throughout your recovery journey.

Frequently Asked Questions

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a condition where the median nerve in your wrist is compressed, causing pain, numbness, and tingling in your hand and fingers.

Carpal tunnel injections involve injecting a corticosteroid medication into the carpal tunnel to reduce inflammation and alleviate symptoms of carpal tunnel syndrome.

The corticosteroid medication in the injection reduces inflammation around the median nerve, providing relief from pain, numbness, and tingling.

The procedure is quick and involves using ultrasound guidance to accurately inject the corticosteroid into the carpal tunnel. Local anesthetic may be used to minimize discomfort.

Most patients experience only mild discomfort. A local anesthetic is often used to numb the area, making the procedure more comfortable.

Relief can begin within a few days to a week, with the full effect sometimes taking up to a few weeks to be felt.

Side effects are rare but can include temporary pain at the injection site, infection, or a slight increase in blood sugar levels. Your healthcare provider will discuss these risks with you.

 

Carpal tunnel injections provide symptom relief but are not a cure. Additional treatments or surgery may be necessary for long-term management.

 

Carpal tunnel injections are recommended for patients with moderate to severe symptoms who have not found relief with conservative treatments like wrist splints or physical therapy. Your healthcare provider will determine if this treatment is right for you.

The duration of relief varies, but the effects can last from several weeks to several months. Some patients may require additional injections for sustained relief.