What Is Carpal Tunnel Syndrome
Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist. The carpal tunnela narrow, rigid passageway of ligament and bones at the base of the handhouses the median nerve and the tendons that bend the fingers. The median nerve provides feeling to the palm side of the thumb and to the index, middle, and part of the ring fingers . It also controls some small muscles at the base of the thumb.
Sometimes, thickening from the lining of irritated tendons or other swelling narrows the tunnel and compresses the median nerve. The result may be numbness, weakness, or sometimes pain in the hand and wrist . CTS is the most common and widely known of the entrapment neuropathies, in which one of the bodys peripheral nerves is pressed on or squeezed.
How Effective Are Corticosteroid Injections
Injecting corticosteroids near the carpal tunnel is a common treatment. Steroids reduce swelling in the connective tissue, which relieves the pressure on the median nerve. The benefits of corticosteroid injections have been tested in several studies. In these studies, the corticosteroid injections were compared with either non-surgical treatments or injections that didn’t contain any medication .
They found that symptoms improved in many people within the first 2 to 4 weeks of treatment:
- Symptoms improved on their own in about 30 out of 100 people.
- Symptoms improved after corticosteroids were injected in about 75 out of 100 people.
In other words, the treatment provided noticeable short-term relief from symptoms in about 45 out of 100 people.
One of the studies suggests that giving a single injection is just as effective as dividing the dose between two injections given eight weeks apart.
Treatment With More Than One Injection
There are four trials directly comparing injection with surgery, three of which concluded that surgery was better , the other of which found they were equally effective at one year after treatment , but that relapses continued to occur in the injection group after the one year initial follow-up . Taken together these studies suggest that surgery has a greater impact on symptoms overall than a single injection and that the effect is much more likely to be permanent with surgery. However these studies rather fail to address the fact that a small but significant number of patients get very bad results from surgery whereas major complications of injection are extremely rare and none of them are reported in a way which allows one to say how many patients might have been spared surgery by the use of injection.
We have recently repeated a version of this study in Canterbury . We made more determined efforts to find out exactly what had happened to all 254 patients who started treatment with steroids in 2007 during 2015, 8 years later. We eventually concluded that only 41% of the patients had required surgery during that 8 year period. The un-operated patients had had between 1 and 10 injections, with an average of two.
It is also worth noting that, as with the Scottish study, the majority of these patients had NOT been referred for surgery after being followed up for 1 year, suggesting that they considered their symptoms adequately controlled.
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Talking To My Neurologist
I myself see my neurologist next week, and I plan to ask him for a prescription I can keep on hand for migraines I’m unable to break with my current home treatments and rescue medications, particularly since I have had to visit the ER so often and seem to be out of the statistical norm in a few ways already. Here’s hoping!
**Update: my neurologist did give me a Medrol burst and taper pack, but it didn’t seem as effective as the 20 mg Prednisone. I am keeping it in mind as something to talk to my new family doctor about in March!
Management Of Carpal Tunnel Syndrome
ANTHONY J. VIERA, LCDR, MC, USNR, Naval Hospital, Jacksonville, Florida
Am Fam Physician. 2003 Jul 15 68:265-272.
Carpal tunnel syndrome affects approximately 3 percent of adults in the United States. Pain and pares-thesias in the distribution of the median nerve are the classic symptoms. While Tinel’s sign and a positive Phalen’s maneuver are classic clinical signs of the syndrome, hypalgesia and weak thumb abduction are more predictive of abnormal nerve conduction studies. Conservative treatment options include splinting the wrist in a neutral position and ultrasound therapy. Orally administered corticosteroids can be effective for short-term management , but local corticosteroid injections may improve symptoms for a longer period. A recent systematic review demonstrated that nonsteroidal anti-inflammatory drugs, pyridoxine, and diuretics are no more effective than placebo in relieving the symptoms of carpal tunnel syndrome. If symptoms are refractory to conservative measures or if nerve conduction studies show severe entrapment, open or endoscopic carpal tunnel release may be necessary. Carpal tunnel syndrome should be treated conservatively in pregnant women because spontaneous postpartum resolution is common.
Family physicians frequently encounter patients who may have carpal tunnel syndrome. This article reviews the clinical features, diagnosis, and treatment of this relatively common condition.
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Patients And Electrophysiological Assessment
The patients enrolled in the study had clinical symptoms and signs of carpal tunnel syndrome confirmed by standard electrodiagnostic tests. Testing the radial and ulnar nerves showed that they had no abnormalities. Motor and sensory nerve conduction studies were done using standard techniques of supramaximal percutaneous stimulation and surface electrode recording. The nerves sampled were the median, ulnar, and radial nerves. Amplitude and conduction velocity of compound muscle action potentials and sensory nerve action potentials were measured using to the method described by Delisa et al. The electromyographic recordings of motor conduction velocity were made with the filter bandpass at 2 Hz to 10 kHz, a sweep speed of 2 ms/cm, and the amplifier gain adjusted for viewing the CMAP. For measurement of SNAP, the instrument settings were: filters, 20 Hz to 10 kHz sweep, 2 ms/cm gain, 1020 V/cm.
The electrophysiological criteria for the diagnosis of carpal tunnel syndrome were median sensory distal latency more than 3.1 ms or a mixed or sensory median nerve wristpalm conduction time greater than 2.0 ms at a distance of 8 cm, and motor distal latency more than 4.7 ms .
Exclusion criteria were as follows:
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Dextrose Corticosteroids And Surgical Release In Carpal Tunnel Syndrome
| The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government.Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. |
| First Posted : July 10, 2019Last Update Posted : March 11, 2021 |
- Study Details
| Peripheral Nervous System DiseasesNerve Compression SyndromesCarpal Tunnel Syndrome | Drug: Corticosteroid vs. DextroseProcedure: Corticosteroid or Dextrose vs. Surgery | Not Applicable |
Resource links provided by the National Library of Medicine
How Can Carpal Tunnel Syndrome Be Prevented
At the workplace, workers can do on-the-job conditioning, perform stretching exercises, take frequent rest breaks, and use correct posture and wrist position. Wearing fingerless gloves can help keep hands warm and flexible. Workstations, tools and tool handles, and tasks can be redesigned to enable the workers wrist to maintain a natural position during work. Jobs can be rotated among workers. Employers can develop programs in ergonomics, the process of adapting workplace conditions and job demands to the capabilities of workers. However, research has not conclusively shown that these workplace changes prevent the occurrence of carpal tunnel syndrome.
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Carpal Tunnel Syndrome A New Twist For The Wrist
Abstract & Commentary
Wong SM, et al. Local vs. systemic corticosteroids in the treatment of carpal tunnel syndrome. Neurology 2001 56:1565-1567.
The most frequent form of entrapment neuropathy is carpal tunnel syndrome . Patients present with median nerve paresthesias, which may progress or recur enough to interrupt sleep, dexterity, or employment. Several nonoperative therapies are available for CTS, although surgical decompression is regarded as definitive for cure. Occupational disability frequently occurs, escalating this condition to one of major clinical and economic importance.
To evaluate two conservative options for this neuropathy, Wong and colleagues studied 60 patients in Hong Kong with CTS. These patients had: 1) sensory symptoms over the median nerve distribution, 2) nerve conduction velocity and electromyographic studies of median and ulnar nerves that confirmed CTS by American Academy of Neurology criteria, and 3) failed splinting for two months. Cases were excluded if they had received prior steroids for CTS, had disorders associated with CTS , or had severe CTS requiring surgical decompression based on the presence of thenar wasting or fibrillation on EMG.
References
1. Herskovitz S, et al. Low dose, short term oral prednisone in the treatment of carpal tunnel syndrome. Neurology 1995 45:1923-1925.
2. Chang MH, et al. Oral drug of choice in carpal tunnel syndrome. Neurology 1998 51:3909-3913.
Carpal Tunnel Syndrome: How Effective Are Corticosteroid Treatments
Treating carpal tunnel syndrome symptoms with corticosteroids can provide temporary relief. Corticosteroid injections into the carpal tunnel are more effective than corticosteroids taken as tablets.
Pain, tingling or numbness in your hand may possibly be caused by carpal tunnel syndrome. In carpal tunnel syndrome, the median nerve that runs through the carpal tunnel in your wrist is squashed. This nerve leads to the ball of the thumb and other parts of the hand. Injecting corticosteroids is one of the most effective treatments available.
Natural steroids are made in the adrenal glands. They have various effects, such as reducing inflammation and swelling. The steroids used in medications are made artificially. In the treatment of carpal tunnel syndrome, corticosteroids are typically considered if wearing a splint hasn’t made any difference. The corticosteroid can either be injected into the tissue as a solution or taken as a tablet. The injections are more common and more effective than the tablets.
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How Is Carpal Tunnel Syndrome Treated
Treatments for carpal tunnel syndrome should begin as early as possible, under a doctor’s direction. Underlying causes such as diabetes or arthritis should be treated first.
Non-surgical treatments
- Splinting. Initial treatment is usually a splint worn at night.
- Avoiding daytime activities that may provoke symptoms. Some people with slight discomfort may wish to take frequent breaks from tasks, to rest the hand. If the wrist is red, warm and swollen, applying cool packs can help.
- Over-the-counter drugs. In special circumstances, various medications can ease the pain and swelling associated with carpal tunnel syndrome. Nonsteroidal anti-inflammatory drugs , such as aspirin, ibuprofen, and other nonprescription pain relievers, may provide some short-term relief from discomfort but havent been shown to treat CTS.
- Prescription medicines. Corticosteroids or the drug lidocaine can be injected directly into the wrist or taken by mouth to relieve pressure on the median nerve in people with mild or intermittent symptoms.
- Alternative therapies. Acupuncture and chiropractic care have benefited some individuals but their effectiveness remains unproved. An exception is yoga, which has been shown to reduce pain and improve grip strength among those with CTS.
Surgery
Recurrence of carpal tunnel syndrome following treatment is rare. Less than half of individuals report their hand feeling completely normal following surgery. Some residual numbness or weakness is common..
How Does The Injection Process Work And How Long Until I Get Some Relief
The injection is made into the carpal tunnel in the wrist, and research shows that ultrasound can be used to improve a physicians ability to position the needle so that the risk of injury to the median nerve is minimized and the steroids reach the carpal tunnel without injuring nearby tissue. Almost half of patients who undergo steroid injections for CTS find relief from their symptoms in less than a month after the procedure.
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More On Steroid Injection For Cubital Tunnel Syndrome
Cortisone is a powerful anti-inflammatory that reduces inflammation and pain. In cases of cubital tunnel syndrome, cortisone is injected at the site of the nerve trapping. Generally, the key is to put cortisone above and below the site of nerve trapping. In general, ultrasound improves the accuracy and effectiveness of cortisone injection by targeting the exact location of nerve compression.
Where Can I Get More Information
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network at:
Office of Communications and Public LiaisonNational Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesda, MD 20892
NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.
All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.
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What Are The Risks Of A Carpal Tunnel Ultrasound And Injection
This is a very safe procedure with few significant risks, but occasionally problems are experienced.
What Happens During A Carpal Tunnel Ultrasound And Injection
You will be taken into the scanning room by the sonographer . You will either be lying on a scanning bed or sitting down with your hand on a table or bed in a comfortable position. The sonographer will apply gel over your wrist and take images using ultrasound. These images will then be shown to the radiologist who will discuss them with you and might take some further images.
If carpal tunnel syndrome is confirmed, and the radiologist recommends an injection, the procedure will be explained to you. You will be able to ask any questions at this time. The skin over your wrist is cleaned with antiseptic liquid. A small needle is passed through your skin directly into the carpal tunnel using ultrasound images to guide the placement of the needle. A small amount of corticosteroid and local anaesthetic is then injected, and the needle removed. Most people are surprised by how quick and easy the procedure is.
The radiologist will give you advice for after the injection. The wrist and hand should generally be rested completely for 6 hours, followed by minimal use for between 1 and 3 days.
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Sinus Infection And Migraine
However, by Monday I felt flattened. I had made it through the weekend, and then got hit by some sort of sinus/cold situation. I had muscle aches too, and I could only wait three days of barely being able to move before returning to urgent care. We have a wonderful facility associated with our local hospital and the university where John teaches, and since I’m between family doctors due to the new insurance it is my go-to for everything except migraine. I got a different doctor this time, and he was also very sympathetic. I described my symptoms, particularly the sinus pain and how it was exacerbating my migraines, and that Sudafed wasn’t working. He diagnosed me with probable influenza and a sinus infection, and prescribed Amoxicillin and what do you know? – Prednisone. For the sinus inflammation. 5 days, again, but this time two 20 mg tablets per day.
