Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) is a painful disorder of the wrist, hand, or arm. CTS is caused by pressure on the median nerve in the wrist.

People at risk for carpal tunnel syndrome include people who work with their hands (including secretaries, IT professionals, assembly line workers, musicians, painters) and people with certain medical conditions (including diabetes, low thyroid function, pregnancy, obesity).

Carpal tunnel syndrome (CTS) is very common. At any given time, 3% to 10% of the general population has CTS.  Costs exceed $500 million annually, and people who have CTS lose, on average, 84 days of income.

What are the symptoms of carpal tunnel syndrome?

Symptoms of CTS include:

• Pain, numbness, or tingling in the hand, wrist, or arm
• Pain that gets worse with use
• Pain that wakes you up at night
• Dropping things from the hands
• Hand weakness

How is carpal tunnel syndrome diagnosed?

In some patients, carpal tunnel syndrome (CTS) can be suspected based on history and examination alone. Most doctors prefer to diagnose CTS with the help of tests. The most common, and oldest, test for CTS is electrodiagnostic testing (also known as nerve conduction studies, NCV, EMG or EDX).In the last few years, neurologists have started to use ultrasound to help in the diagnosis of CTS. Our AANEM  (American Association of Neuromuscular and Electrodiagnostic Medicine) accredited neuromuscular lab at LMG-Neurology offers high resolution ultrasound for both diagnosis and treatment of carpal tunnel syndrome.

What are the benefits of using ultrasound to diagnose carpal tunnel syndrome?

Electrodiagnostic information is helpful, but tests the nerves only.  It does not provide any other information about other things that may be important, like tendons, bones, and blood vessels.High-resolution ultrasound (HRUS) works with electrodiagnostic testing to show real-time pictures of the nerves and other tissues. HRUS allows measurements of the median
nerve which can confirm CTS with a high degree of accuracy. Best of all HRUS is a painless way to diagnose. 

What are the treatment options for carpal tunnel syndrome?

There are many options for treating CTS.  They include:

• Do nothing (Sometimes CTS goes away on its own.)
• Wrist splints, stretches and exercises
• Carpal tunnel injections (either with or without the guidance of high-resolution ultrasound)
• Carpal tunnel surgery

How do carpal tunnel syndrome injections work?

For many years, doctors have done steroid injections to treat carpal tunnel.  Many years of experience have shown that steroid injections into the carpal tunnel are helpful. (Individual results vary on a case by case basis, and CTS injections may not help some people, and can cause injury.)

Advantages of using injections to treat carpal tunnel syndrome include:

• Lower cost than surgery
• Shorter recovery time (usually a few days, not weeks)
• Do not usually have to take time off work
• Lower complication rate than surgery (about 1 in 1000)
• Can be repeated if needed
• Doesn't prevent future surgery if needed

What are the benefits of ultrasound-guided injections?

Before high-resolution ultrasound, doctors used landmarks on the surface of the wrist to guess where to place the injection. This method is called a “blind” injection. Limitations of blind injections include:

• Not every wrist looks like the anatomy book
• The median nerve slips around inside the wrist depending on wrist and finger position

High-resolution ultrasound can use real-time video imaging to:

• See exactly where the median nerve is, even if it moves
• See exactly where the injection needle and needle tip are
• Avoid other structures
• Place the medicine right where it needs to be
• Watch the medicine go in

Providers using ultrasound guided carpal tunnel injections:

H. Alexander Krob, M.D.


Legacy Medical Group - Neurology
2121 NE 139th Street Suite 400
Vancouver, WA 98686
Phone: 360-487-4707
fax: 360-487-4709