Carpal Tunnel Syndrome

Carpal tunnel syndrome is a fairly common complaint, often associated with keyboarding and other activities that demand repetitive use of the wrist, hand and fingers. While the condition is not serious, it can be painful, making it difficult to perform everyday tasks. Carpal tunnel syndrome is most likely to appear in the dominant hand, but it may occur in either or both hands.

Carpal Tunnel Anatomy

The carpal tunnel is a narrow passageway formed by the carpal bones of the wrist and the transverse carpal ligament. The median nerve travels from the neck, down the arm, and passes through the carpal tunnel at the wrist on its way to the hand and fingers. The median nerve provides sensation in the thumb, index, middle, and ring fingers, and innervates the muscles at the base of the thumb. Nine flexor tendons that bend the fingers also pass through the carpal tunnel.

Because the tunnel is a relatively crowded space with rigid walls, inflammation of any tissues within the tunnel can put pressure on the median nerve and restrict its ability to glide.

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Carpal Tunnel Symptoms

Symptoms of carpal tunnel syndrome include:

  • Pain, numbness or tingling in the thumb and fingers
  • Pain or numbness that travels up the arm
  • Weakened or clumsy hands
  • Pain at the base of the thumb

Carpal tunnel symptoms are often worse upon rising in the morning.

Carpal Tunnel Causes

Carpal tunnel causes may involve a combination of factors. Some of the most common causes include:

  • Anatomically narrow carpal tunnel due to genetics
  • Repetitive motion like keyboarding that overuses the flexor tendons
  • Excessive use of vibrating power tools
  • Hormonal fluctuations that cause fluid retention in the wrist and hand
  • A cyst or tumor in the tunnel
  • Certain medical conditions like diabetes, arthritis, and thyroid gland imbalances

Carpal Tunnel Syndrome Diagnosis

Because hand pain can be triggered by a number of factors, accurate diagnosis is key to appropriate treatment. At NYDNR, we use real-time diagnostic ultrasound to view the structures of the wrist and hand in motion, to zero in on the exact cause of pain. Once carpal tunnel syndrome is confirmed, we devise an individualized carpal tunnel treatment plan for each patient.

Carpal Tunnel Syndrome Treatment

Traditional treatment for carpal tunnel syndrome often involves rest, splinting, NSAIDs, and steroid injections to reduce inflammation and ease pain. However, for patients whose occupation demands daily keyboarding or tool use, traditional pain management strategies may not be effective.

At NYDNR, we use the most innovative therapies and cutting edge technologies to promote carpal tunnel relief and restore pain-free function to your wrist and hand.

Treatment for carpal tunnel pain relief at NYC DNR may include:

ESWT (extracorporeal shock wave therapy):

Shock waves present a non-invasive treatment option to reduce pain and inflammation in affected tissues within the tunnel, reducing pressure on the median nerve.

Ultrasound guided nerve hydro-dissection:

This minimally invasive method is often used in conjunction with other therapies to reduce median nerve entrapment and restore blood supply to the hand.

Ultrasound Guided Dry Needling:

Using ultrasound elastography, we identify which trigger points will be most effective in the treatment of each patient. Using this technique, we’re able to instantly relieve proximal, and distal median nerve compression.

Neurodynamic nerve mobilization:

Nerve mobilization exercises promote smooth gliding of the median nerve along its entire pathway.

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Additional therapies may include acupuncture, myofascial release techniques, joint mobilization and ligament-strengthening exercises.

Best Carpal Tunnel Doctor in NYC

If you suffer from ongoing wrist and hand pain and numbness, you may have carpal tunnel syndrome. The wrist and hand pain specialists at NYDNR understand how important full use and function of your hands can be.

We provide the most advanced clinically proven treatment options to accelerate healing and restore full function to your wrist, hand and fingers, so you can get on with your busy life.

Carpal Tunnel Syndrome
The initial symptoms of carpal tunnel syndrome are hand numbness, tingling, and burning. Initially the symptoms occur intermittently and worst at nighttime while the patient is sleeping. The tingling often wakes up the patient, and they have to shake their hands to get rid of it. As the disease progresses the frequency and the intensity of the tingling and burning increases, eventually the symptoms become constant and severe. As the carpal tunnel syndrome gets worst the patient can develop symptoms of weakness and paralysis of the fingers and the hands.

Causes of Carpal Tunnel Syndrome

Tingling is usually a sign of nerve injury. Nerves generally have two major functions. There are sensory nerves which sense information in the skin, and there are motor nerves that are used to move the muscles. Several symptoms occur when there is nerve injury, there could be numbness, tingling, or burning and there could also be associated weakness and paralysis of the muscles. One of the nerves that supply the hand is called the Median nerve. This nerve travels across the wrist to supply the fingers. With repetitive bending and straightening of the wrist this nerve gets injured; Injury of the Median nerve at the wrist causes carpal tunnel syndrome. It tends to occur in people that use the computer frequently, use the cash register, or are involved in activities that involve repetitive motion at the wrist. There is greater frequency of carpal tunnel syndrome among post-menopausal women.

Diagnosis

The diagnosis of carpal tunnel syndrome is made using a nerve test called EMG/Nerve conduction study. Since there are multiple other causes of hand tingling, nerve testing is crucial to know if the Median nerve is injured at the wrist, which would confirm the diagnosis of carpal tunnel syndrome, or is there another cause. It also gives us crucial information about how severe the injury is, which determines the type of treatment. Another very helpful diagnostic procedure is musculoskeletal ultrasound. It further helps us to identify the cause, location and size of damaged nerve. Rapid diagnosis of carpal tunnel syndrome is important since if the problem is ignored the injury could continue and the symptoms could progress and become permanent.

Treatment

Once the diagnosis of carpal tunnel syndrome is made we will determine the best possible treatment for the patient trying to prevent further nerve damage and trying to reverse the process. The different treatment options include bracing, injections, special physical therapy release and exercise methods, extracorporeal shockwave therapy. The treatment of carpal tunnel syndrome that is chosen depends on the severity of nerve damage shown on the nerve conduction study and diagnostic ultrasound, making this test very crucial. The earlier in the disease process that we see the patient the better chances of recovery. The later in the course the patient comes to our attention the chances of recovery are less, the patient could develop permanent paralysis, and surgical procedures might be required even though they could have been avoided early in the disease course. Patients with carpal tunnel syndrome could have full recovery with minimal intervention if they seek medical attention and treatment early.

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Research at NYDNRehab

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

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Complete tear of rectus femoris
with large hematoma (blood)

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Separation of muscle ends due to tear elicited
on dynamic sonography examination

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