Carpal Tunnel Syndrome

Dr. Marc Darrow, M.D.. J.D.

 The overuse epidemic of the computer age CTS is a compression of the median nerve at the wrist, leading to numbness tingling and pain in the hand. The median nerve passes through the carpal tunnel at the wrist and into the palm where it sends branches that control feeling to the thumb, index, middle and half of the ring finger. Symptoms include tingling, pain or numbness in the hand and fingers.

The biggest problem with carpal tunnel syndrome is that it is highly over-diagnosed. Doctors unfamiliar with trigger points and the referred pain theory often overlook the true causes of problems in the areas associated with carpal tunnel. The most common reasons for misdiagnosis of CTS is weakness in the annular ligament of the elbow, or referred pain from the cervical vertebrae to the thumb, index and middle fingers. A problematic annular ligament when pressed may be a trigger point to the carpal tunnel distribution in the hand. Once the annular ligament is injected with Prolotherapy or trigger point therapy, it is often deactivated and the symptoms of carpal tunnel syndrome disappear.

Traditional methods of treating CTS include wearing a splint at night or injections of cortisone to reduce swelling. If these measures are not successful, carpal tunnel release surgery, which sections the tough transverse carpal ligament and relieves pressure on the median nerve, may be performed. But surgery should be the last treatment a patient should ever consider. Countless patients have presented to my office with worse symptoms after they had the carpal tunnel surgery.

Prolotherapy to strengthen the annular ligament will often cure chronic elbow pain.

Saline Injections
We have been having great luck with injection of saline around the median nerve to release it from surrounding tissue. A tiny needle is used under ultrasound guidance. It takes a minute and alleviates the carpal tunnel syndrome without surgical release.

Under no circumstances should a patient consent to surgery for CTS until an evaluation is performed by a physician trained in the referral patterns of pain in ligaments.