INJECTION THERAPY FOR CARPAL TUNNEL SYNDROME (CTS)

What is Carpal Tunnel Syndrome (CTS)

Carpal tunnel syndrome is a painful, debilitating condition that can make it difficult to do ordinary daily tasks like gripping and can cause substantial night agony and discomfort. Pressure on the median nerve, which is located on the inside of the wrist, causes it to swell. It is common among pregnant and postpartum women, as well as individuals who work in physical labour, such as builders, and those who spend long hours at a computer with poor ergonomics and posture. It’s also linked to other medical issues including diabetes and thyroid issues like hypothyroidism.
Carpal tunnel syndrome treatment differs depending on the particular source of your problem. Physiotherapy, activity adjustment, and anti-inflammatories can help relieve your pain symptoms. A wrist splint can help reduce pressure on the nerve by maintaining your wrist in a neutral posture, especially during night. To alleviate your discomfort, we recommend wearing a wrist splint at night for at least four weeks. If your symptoms do not improve, an ultrasound-guided steroid injection to ease the pressure on the nerve is recommended. Before considering surgical intervention, we always propose a steroid injection because many procedures can be avoided.

What are the symptoms of Carpal Tunnel Syndrome?

Carpal tunnel syndrome causes the following symptoms:

  • Pain in your fingers and hands, especially in the pad of your thumb, index, and middle finger.
  • Weakness and a hard time gripping.
  • Pins and needles, as well as numbness in the hand, making you desire to shake it to relieve the sensations.

If this sounds like you, keep reading…

What disorders can be mistaken for Carpal Tunnel Syndrome?

If this does not sound like your pain, there are a number of other conditions that might cause it, including:

  • Wrist osteoarthritis, a type of osteoarthritis that affects the joints in the wrist.
  • Tenosynovitis of DeQuervain
  • Thumb osteoarthritis,  a type of osteoarthritis that affects the joints of the thumb.
  • Scapholunate ligament injury due to a rip in the triangular fibrocartilage complex (TFCC).

Carpal tunnel syndrome vs. wrist osteoarthritis (OA):

The primary difference is that carpal tunnel syndrome is a nerve compression that causes pins and needles and hand weakness, but osteoarthritis of the wrist affects the joint and does not cause similar nerve-related symptoms. Wrist Carpal tunnel syndrome is not linked with severe stiffness and edoema at the wrist joint, unlike osteoarthritis, which causes thickening and swelling of the wrist joint with pain and stiffness.

Anatomy

The carpal tunnel is a channel made up of tendons, ligaments, and bones that connects the wrist to the hand. The median nerve runs through the tunnel, providing feeling to the thumb, index, middle, and thumb side of the ring finger. Carpal tunnel syndrome (often referred to as CTS) is a prevalent ailment that affects up to 16% of the population in the United Kingdom. Carpal tunnel syndrome affects three times as many women as it does males. New mothers, manual labourers such as builders and bricklayers, and individuals who spend a lot of time at their desk are all susceptible to it.

Carpal tunnel syndrome is a disorder that affects the wrist and hand, causing discomfort, pins and needles, and numbness (reduced/altered sensation). These symptoms are typically felt in the pattern depicted in the diagram below. Symptoms are frequently worse at night, first thing in the morning, or after lengthy computer use.
Carpal tunnel syndrome can also cause hand and wrist weakness as well as a limited range of motion. Muscle wasting in the hand, particularly the ‘pad’ of the thumb, known as the thenar eminence, can occur in more severe or long-term/chronic cases.

What is the Carpal Tunnel?

The wrist’s carpal tunnel is a space or canal (see image below). It’s a little area with a lot of anatomical structures in it. It is made up of nine tendons as well as the median nerve. Carpal tunnel syndrome is caused by a compression of the median nerve, which is one of three nerves in the forearm.

How to diagnose Carpal Tunnel Syndrome?

A diagnosis and cause will be determined after a complete assessment and physical examination. One of our specialist clinicians, all of whom have extensive experience with this condition, will perform this procedure.

A diagnostic ultrasonography scan will also be performed to visualise the median nerve. The median nerve is swollen in carpal tunnel syndrome. On ultrasonography, the increase in nerve size can be seen clearly and easily compared to the other side to help confirm the diagnosis. When it comes to diagnosing carpal tunnel syndrome, ultrasound is just as reliable as nerve conduction testing. This will be completed within your scheduled appointment time, and there will be no additional charge.
Other illnesses that can resemble the symptoms of carpal tunnel syndrome must also be ruled out. Referral from the neck is one of the most common illnesses that mimics the symptoms. Compression of a nerve in the neck, such as from a disc condition, can produce discomfort, pins and needles, and numbness in the wrist and hand.

What causes Carpal Tunnel Syndrome?

The carpal tunnel goes through the median nerve, which is prone to discomfort. Excessive usage of the wrist, specifically the flexor tendons in the carpal tunnel, can result in medial nerve irritation and swelling. There is also a ligament called the transverse ligament that spans over the top of the tunnel and can thicken, putting greater pressure on the nerve.
Carpal tunnel syndrome is not limited to persons who work in a specific career or have a specific lifestyle.The search for the cause of CTS is still ongoing.
A comprehensive examination may usually give you a good indication of what’s going on. The following are examples of possible causes:

  • The wrists are under a lot of stress or are overworked.
  • Arthritis of the wrist 
  • Daibetes
  • The wrist has been injured.
  • Hormonal shifts
  • Pregnancy
  • Thyroid glands that are underactive
  • Medications

To minimise lasting injury to the median nerve, it is critical to have a diagnosis and treatment as soon as possible.

How do you treat Carpal Tunnel Syndrome?

An ultrasound-guided injection, personalised physiotherapy, and lifestyle adjustments may all be part of a specific treatment strategy. This will be determined by the severity of your ailment and previous treatments.
We’ll also take into account influencing factors like your posture and work environment.
We recommend getting a workstation assessment if your symptoms begin as a result of extended sitting at a desk.
Over-the-counter and prescription medications are two more non-surgical options.
A two-week trial of wrist splints may also be recommended (see image below). We recommend that patients simply wear the splint at night to see if their symptoms improve. The splint retains the nerve in a neutral posture, giving the carpal tunnel some breathing room. This may provide enough time for the nerve’s irritation to subside and symptoms to fade. Splints are available from most pharmacies.

Are Steroid Injections effective for Carpal Tunnel Syndrome?

An ultrasound scan of the median nerve is also part of our evaluation, which might reveal any thickness or structural abnormalities. This will allow us to decide whether an ultrasound-guided steroid injection will be beneficial.
Carpal tunnel syndrome can be effectively treated with ultrasound-guided injections.

Under ultrasound guidance, corticosteroid (also known as steroid) is administered near to the nerve in the carpal tunnel. This ensures great precision, maximising effectiveness and minimising complications and adverse effects as a result. The treatment is also less painful when done with ultrasound assistance. Corticosteroid is an effective anti-inflammatory drug. Steroids are one of the most often utilised medications for injury diagnosis, treatment, and prevention. Cortisone is a potent anti-inflammatory with a low risk of side effects. Ultrasound-guided injections are a popular option and incredibly safe. At Joint  Injections, we have a lot of experience with ultrasound-guided injections.

The National Institute for Health and Care Excellence recommends steroid injections for carpal tunnel syndrome (NICE).

The American Academy of Orthopaedic Surgeons and the College of Occupational and Environmental Medicine found convincing evidence that steroid injections can help people with carpal tunnel syndrome improve their pain and function. Patients with acute (less than 6 weeks), sub-acute (6 weeks to 12 weeks), and chronic (more than 12 weeks) symptoms were studied. (You may find these suggestions here.)

 How many injections can you have for Carpal Tunnel Syndrome?

Many of our clients only require one injection, which provides enough pain relief. Splints and physiotherapy are frequently used in conjunction with this treatment. You may need more than one steroid injection if you have an underlying illness that is contributing to your condition, such as thyroid difficulties, arthritis, or diabetes.

If the ultrasound scan reveals a thick, swollen nerve, you may need more than one injection to adequately relieve the inflammation.

It’s critical to address as many of the relevant elements as feasible in order to reduce the number of injections needed. Here are a couple of ideas:

  • Limit the amount of time you spend on a computer or in an uncomfortable sitting position.
  • Every 30 minutes, take a break from your computer and get some fresh air.
  • Use a standing desk for short periods of time during the day, and do some simple wrist stretches every 30 minutes at your desk.
  • Maintain a healthy lifestyle by staying fit, active, and hydrated.

Carpal Tunnel-Is Surgery an option?

Surgery is a possibility for this problem, but it should only be used in the most severe situations where conservative treatment has failed. Surgery is generally considered unnecessary unless a steroid injection has failed to alleviate symptoms.

For CTS, there are two types of surgery: open release surgery and endoscopic surgery. Both procedures entail severing a ligament surrounding the wrist in order to relieve pressure on the median nerve.

Despite the fact that the procedure is only 20-30 minutes long, the recovery period is 4-6 weeks long and includes physiotherapy.

Joint Injection’s experts are dual-trained, highly specialised physiotherapists and musculoskeletal sonographers with extensive experience diagnosing all hand and wrist disorders, including Carpal Tunnel Syndrome. We provide a ‘one-stop’ clinic, which means you’ll get an examination, a diagnostic ultrasound, and, if necessary, an ultrasound-guided injection.