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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.
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.
Symptoms of carpal tunnel syndrome include:
Carpal tunnel symptoms are often worse upon rising in the morning.
Carpal tunnel causes may involve a combination of factors. Some of the most common causes include:
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.
Please explore more advanced diagnostic option unavailable anywhere else:
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.
This minimally invasive treatment method is often used in conjunction with other therapies to release median nerve entrapment and restore blood supply to the hand.
Ultrasound guided dry needling (USGDN):Using ultrasound elastography, we identify the location of trigger points and insert a dry needle that triggers a twitch response in the tight tissue, instantly relieving proximal and distal median nerve compression.
Neurodynamic nerve mobilization:Nerve mobilization exercises help the median nerve to glide smoothly along its entire pathway.
Electromagnetic transduction therapy (EMTT):EMTT uses pulsed electromagnetic fields (PEMFs) to deliver low frequency currents to the carpal tunnel region, to influence the firing patterns of the median nerve and relieve pain.
Extracorporeal shock wave therapy (ESWT):
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.
Learn more about the efficacy of ESWT for carpal tunnel here:
Additional therapies may include acupuncture, myofascial release techniques, joint mobilization, and ligament strengthening exercises.
Additional therapies may include acupuncture, myofascial release techniques, joint mobilization and ligament-strengthening exercises.
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.
Dr.Kalika revolutionized foot and ankle care by using high resolution diagnostic ultrasonography for structural diagnosis, combined with with gait and motion analysis technology. Dr.Kalika’s motion and gait analysis lab is the only private lab in the US that features research-grade technology found only at top research universities, made available to patients in his private clinic.
HyunJu
YOO, PT, MPT, DPT, CPI (Licensed Physical Therapist)
Dr. Christina Pekar
DC
Dr. Michelle Agyakwah
DC
Mariam Kodsy
Physical Therapist
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.
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.
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.
Below is a prime example of how ultrasound can take the guesswork out of diagnosis.
A bad physical therapy experience is one of the primary causes of unnecessary surgery
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)
Complete tear of rectus femoris
with large hematoma (blood)
Separation of muscle ends due to tear elicited
on dynamic sonography examination
