Surgery is a common go to when it comes to Carpal Tunnel Syndrome. But is surgery inevitable? Although the standard practice of modern medicine is to inject steroids or to prescribe anti-inflammatory medications, the end result with a diagnosis of carpal tunnel syndrome is usually surgery. Is surgery the answer?

<strong>Carpal Tunnel Release Surgery Has Varying Degrees of Success</strong>

[caption id="attachment_5896" align="alignright" width="300"]<img class="wp-image-5896" src="https://www.drfields.com/wp-content/uploads/2023/09/Carpal-tunnel-500x419.png" alt="Carpal Tunnel" width="300" height="251" /> Carpal Tunnel[/caption]

Carpal Tunnel surgery has limited and widely varying degrees of success in treating carpal tunnel syndrome. The journal <em>Muscle &amp; Nerve: Official Journal of the American Association of Electrodiagnostic Medicine</em> says, "years after its widespread recognition, a significant minority of patients with carpal tunnel syndrome continue to experience poor outcomes from treatment." With over 600,000 carpal tunnel release surgeries performed annually in the U.S., that would account for quite a lot of failures.

Some of the failures are due to misdiagnosis where the surgeon does not treat the true cause of the problem, considering that it is not always the median nerve causing the symptoms. In our office, we have seen patients with carpal tunnel-like symptoms, who actually have symptoms caused by a ligament injury. To ascertain the source, a complete history and evaluation must be completed.

<strong>Injured Ligaments Can Cause Symptoms of Carpal Tunnel Syndrome</strong>

Ligament laxity may be the source of the symptoms. A complete history and evaluation is needed prior to making the diagnosis of carpal tunnel syndrome. Electrodiagnostic studies and imaging may be necessary. Additionally, a physician who understands the referral patterns of ligaments should evaluate the individual with this condition before surgery is considered. Because most physicians do not know the referral pain patterns of ligaments, they do not realize that the cervical vertebrae 4 and 5 and the annular ligament can refer pain to the thumb, index, and middle fingers. Ligament laxity can also cause numbness. Cervical and annular ligament laxity should always be evaluated prior to making a diagnosis of carpal tunnel syndrome.

Regenerative Orthopedics repairs injured and weakened ligaments. If ligaments are the source of the problem, then these treatments, which specifically address injured ligaments, can be sought.

<strong>Why Cut Unnecessarily?</strong>

Ligament injury can often cause a variety of symptoms. And when carpal tunnel surgery is performed, ligaments are cut. Why chance additional injury if cutting is not necessary. A 2023 article in the <em>Journal of biomechanical engineering</em> says “Carpal tunnel release surgery transects the transverse carpal ligament to expand the tunnel arch space, decompress the median nerve, and relieve the associated symptoms. However, the surgical procedure unavoidably disrupts essential anatomical, biomechanical, and physiological functions of the wrist, potentially causing reduced grip strength, pillar pain, carpal bone instability, scar tissue formation, and perineural fibrosis.” Looking into non-surgical alternative may be the answer to avoid this problem.

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<strong>Actual Carpal Tunnel Syndrome vs Ligament Injury (Pseudo-Carpal Tunnel Syndrome)</strong>

Actual carpal tunnel syndromes are caused by compression of the median nerve and pseudo carpal tunnel syndromes are caused by ligament weakness. They both may present with the same or similar symptoms but have entirely different pathology.

As stated earlier, when ligaments are the source, Regenerative Orthopedic injections to the injured ligaments results in the strengthening and repair of these structures. The ligaments become tighter and stronger, eliminating the causative factor.

The medical journal<em> Pain Management</em> concluded that Dextrose Prolotherapy was effective for improving pain intensity, limitations in daily life, electrophysiologic parameters, and ultrasonographic outcomes.(3)

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<strong>OrthoRegen's Approach to Carpal Tunnel Syndrome</strong>

Regenerative Orthopedics works well to treat the pain, numbness, and tingling associated with ‘pseudo’ carpal tunnel syndrome or when the symptoms of carpal tunnel syndrome are caused by ligament damage. If symptoms of carpal tunnel syndrome are found to be due to weak ligaments in the wrist, then Regenerative Orthopedics would be recommended to strengthen the affected wrist ligaments.

If a person has significant tenderness over the lateral elbow (radius) and no evidence of muscle atrophy (weakness) or sensory deficit in the hand, it is likely they have ‘pseudo’ carpal tunnel syndrome. The annular ligament, which enables the hand to rotate, becomes lax through use in repetitive tasks or athletics, leading to chronic pain in the elbow and/or referred pain in the wrist. These ligaments have referral pain patterns that travel down to the wrist and fingers and may be confused with carpal tunnel syndrome. When examining a patient with these symptoms, it is important to examine the elbow as well. Prolotherapy treatments to the lateral collateral ligament (i.e. the radial collateral ligament) and annular ligament of the elbow will help to strengthen these tissues and stop the pain referral patterns down the arm and into the fingers. This problem occurs commonly in people who type frequently or use their arms and elbows a lot at work, such as workers, carpenters, or hairdressers. While operations for carpal tunnel syndrome are sometimes needed, many times Regenerative Orthopedics can help eliminate the need for surgery and cure a patient’s chronic pain.

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<strong>References</strong>
<ul>
 	<li>Bland, Jeremy DP. "Treatment of carpal tunnel syndrome." <em>Muscle &amp; Nerve: Official Journal of the American Association of Electrodiagnostic Medicine</em>2 (2007): 167-171.</li>
 	<li>Li ZM. Non-Surgical Carpal Arch Space Augmentation for Median Nerve Decompression. Journal of Biomechanical Engineering. 2023 Aug 1;145(8):080801.</li>
 	<li>Babaei-Ghazani A, Moradnia S, Azar M, Forogh B, Ahadi T, Chaibakhsh S, Khodabandeh M, Eftekharsadat B. Ultrasound-guided 5% dextrose prolotherapy versus corticosteroid injection in carpal tunnel syndrome: a randomized, controlled clinical trial. Pain Manag. 2022 Jul 18. doi: 10.2217/pmt-2022-0018. Epub ahead of print. PMID: 35848821.</li>
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