What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. The gradual ischemia resulting from high pressure with accompanying compression of the median nerve (MN) within the carpal tunnel is thought to contribute to the pathogenesis of CTS.
What Causes Carpal Tunnel Syndrome?
Carpal tunnel syndrome is caused by pressure on the median nerve. The carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of your hand. When the median nerve is compressed, the symptoms can include numbness, tingling and weakness in the hand and arm.
Most cases of CTS have no specific cause, although any or all of the following risk factors may contribute:
- Frequent, repetitive, small movements with the hands (such as with typing or using a keyboard).
- Frequent, repetitive, grasping movements with the hands (such as with sports and certain physical activities).
- Joint or bone disease (for example, arthritis, osteoarthritis, or rheumatoid arthritis)
- Hormonal or metabolic changes (for example, menopause, pregnancy, or thyroid imbalance).
- Changes in blood sugar levels (may be seen with type 2 diabetes)
- Other conditions or injuries of the wrist (for example, strain, sprain, dislocation, break, or swelling and inflammation).
- Family history of carpal tunnel syndrome.
What are the Symptoms of Carpal Tunnel Syndrome?
CTS can cause inflammation of the intercarpal tendon including the flexor pollicis longus, deep and superficial flexor tendons. The inflammation of the tendon frequently produces a cycle of intercarpal swelling causing further compression of the median nerve. Typical symptoms include:
- Weakness when gripping objects with one or both hands.
- Pain or burning sensation in the fingers (controlled by the MN).
- Nocturnal paresthesia.
- Thenar muscle wasting might occur in chronic stages.
There are no proven strategies to prevent carpal tunnel syndrome, but you can minimize stress on your hands and wrists with these methods:
- Reduce your force and relax your grip. If your work involves a cash register or keyboard, for instance, hit the keys softly. For prolonged handwriting, use a big pen with an oversized, soft grip adapter and free-flowing ink.
- Take short, frequent breaks. Gently stretch and bend hands and wrists periodically. Alternate tasks when possible. This is especially important if you use equipment that vibrates or that requires you to exert a great amount of force. Even a few minutes each hour can make a difference.
- Watch your form. Avoid bending your wrist all the way up or down. A relaxed middle position is best. Keep your keyboard at elbow height or slightly lower.
- Improve your posture. Incorrect posture rolls shoulders forward, shortening your neck and shoulder muscles and compressing nerves in your neck. This can affect your wrists, fingers and hands, and can cause neck pain.
- Change your computer mouse. Make sure that your computer mouse is comfortable and doesn’t strain your wrist.
- Keep your hands warm. You’re more likely to develop hand pain and stiffness if you work in a cold environment. If you can’t control the temperature at work, put on fingerless gloves that keep your hands and wrists warm.
Current Treatment Options
Treatments for CTS range from conservative strategies (medication, steroid injections, night splint, physical therapy) to surgical decompression of the MN. The majority of the patients failed conservative treatment with 60-70% of patients reporting symptoms after 18 months of the treatment. Surgical intervention is more effective, but the failure rate varies from 7-75%.
Regenerative Medicine Treatment
Platelet-rich plasma (PRP) is a biologic product of concentrated platelets that contains several growth factors that promote wound healing, angiogenesis and axon regeneration.
A study by Yung-Tsan Wu, et al. evaluated the efficacy of PRP with 60 patients with mild to moderate CTS. They were injected with one dose of 3 mL of PRP using ultrasound guidance and the control group received a night splint through the study period. The study demonstrated that PRP significantly reduces pain severity and ameliorated disability 6 months post-treatment.
PRP is considered a safe treatment and practiced in many disciplines of medicine. The study demonstrated that the effects of PRP can persist for at least 6 months and researchers believe the effect could continue for more than 6 months.
The mechanism by which PRP has effects in neuropathy is unclear. PRP has been reported to contain a variety of growth factors, including platelet derived growth factor (PDGF), transforming growth factor-β (TGf-β), insulin-like growth factor (IGF), nerve growth factor (NGF) and vascular endothelial growth factor (VEGF). They have all been suggested to play a positive role in the regeneration of injured peripheral nerves.
They concluded that ultrasound-guided PRP injection is safe and effective for treating CTS. PRP continues to be a potential area of further study in peripheral neuropathy and different conditions due to its anti-inflammatory and regenerative properties.
One of the most important biologics in regenerative medicine are mesenchymal stem cells (MSCs), which are a leading investigational therapeutic product because of their multiple mechanisms of action. They have different properties that help them to be of use in many conditions, these properties include differentiation into different tissues, promotion of tissue regeneration, immune regulation, paracrine effect and antiinflammatory properties.
Therapy at Zignagenix
At our clinic we combine the use of MSCs with PRP for the treatment of carpal tunnel syndrome through a localized injection into the affected area and also include intravenous therapy for all of our patients, with excellent clinical outcomes and a high successful rate.
Wu, YT., Ho, TY., Chou, YC. et al. Six-month efficacy of platelet-rich plasma for carpal tunnel syndrome: A prospective randomized, single-blind controlled trial. Sci Rep 7, 94 (2017).