Commentary by Dr. Joseph Hui
Carpal tunnel is a problem that typically results in aching, numbness and tingling, generally affecting the hand. Symptoms are typically worse at night and may wake you from your sleep. Driving, typing, reading and holding a telephone often make the symptoms worse.
It’s unclear why carpal tunnel syndrome develops. Risk factors such as obesity, female gender, diabetes, thyroid issues and pregnancy can lead to swelling of the median nerve. The anatomy of the wrist resembles a tunnel in which the nerve resides. When the nerve swells, it has nowhere to go, resulting in continual squeezing of the nerve leading to the symptoms mentioned above.
Since the nerve is like a wire, the gold standard for its diagnosis involves measuring electrical activity across the nerve at various points using small needles in the arm. This is called an electromyography (EMG) test. Recently, non-invasive tests have been developed using ultrasound to measure the nerve. The main advantage of ultrasound is that it is painless and quick, though its accuracy varies, depending on the person.
Traditional non-surgical treatments include steroid injections, splinting and activity modification. Surgical nerve decompression, the gold standard treatment, involves cutting the ribbon that lies over the top of the tunnel in order to give the nerve more room to swell without being squeezed, thus reducing the symptoms.
Recently, a non-surgical treatment alternative was developed. Using ultrasound guidance, a needle is first inserted adjacent to the nerve, and a combination of numbing medicine, normal saline and a small dose of cortisone is injected in order to bathe the nerve and push it away from the needle. Then, using the same poke, the needle is used as a cutting device, passing back and forth through the ribbon. The procedure is done in the office setting, leading to minimal down time. It also has essentially zero scar formation on the skin. A variety of studies show it can have positive results that are comparable to what you may find two years following a surgery.
If you’re looking for an alternative to surgery, this may be a good treatment option.
