Samuel G Oltman, ND, RMSK
What do you do when your hands are vital for your livelihood and the pain of carpal tunnel syndrome is preventing you from doing your work? Or stopping you from playing your favorite sport? Rest can help but the pain tends to return as soon as you start the activity again. It’s an area of surprisingly little conventional answers for a condition that is so common.
A firefighter who had carpal tunnel syndrome in both hands was referred to me last year. It was making his days grueling and resulting in grip weakness that was negatively affecting his ability to do his job. I used ultrasound imaging to confirm the diagnosis at our first visit. I then discussed treatment options and the evidence for each:
Surgery: It works well initially to decompress the nerve but only has a 60% effectiveness at 5 years and is irreversible (because they snip a ligament in the wrist). The recovery is also much longer than many people can afford (several weeks to several months).
Cortisone injections: Like with so many other conditions, cortisone injections tend to decrease pain in the short term (1 month) but are no better than placebo at 1 year. Compared to other injection options, cortisone also has the highest complication rate.
Rest, ice, NSAIDs: Carpal tunnel syndrome is another condition in which the recommendation of rest, ice and NSAIDs is not evidence based and is purely anecdotal. Ice numbs the pain and does nothing to address the real problem.
D5W: When injected “perineural”, or around the median nerve, D5W decreases pain output from the nerve and increases gliding. Perineural D5W has been shown to be more effective compared to cortisone without the adverse events. It also maintains its effectiveness over the long term (2+ years), unlike cortisone.
PRP: Platelet Rich Plasma is our most commonly utilized regenerative therapy. It can also be injected “perineural”, and is more effective than D5W (and therefore cortisone too) for a longer time, especially in more severe cases.
*Ultrasound Guidance: regardless of what injection is chosen, using ultrasound guidance is an absolute necessity. Ultrasound guidance increases accuracy and effectiveness while decreasing adverse events. This is the standard of care at Cascade Regenerative Medicine and why Dr. Oltman's “RMSK” is so important.
My firefighter patient chose to do PRP injections due to the severity of his pain and his desire to accomplish resolution with as few treatments as possible. After his first treatment the numb/tingling in his hands went away completely but he still had some soreness in the wrists. He had a second treatment about 6 weeks later and he hasn’t needed another one. His pain is resolved with day to day work activities and if he does something that really aggravates the area he’s able to recover by the next day without a big flare. He never took any time off from work.
Contractors, quilters, landscapers, electricians, golfers, and many more are all prone to getting carpal tunnel syndrome. They all may also benefit from a non-surgical approach. See an expert like Dr. Oltman with the training to do it correctly and the experience to guide you through the whole process.
***Dr. Oltman is giving a 2-hour lecture on Carpal Tunnel Syndrome at the upcoming AANP Annual Conference in Scottsdale, AZ. He will outline the role of ultrasound in diagnosis as well as treatment with ultrasound-guided peri-neural injections. He is excited to teach other physicians about the importance of these techniques to improve patient outcomes.
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