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Carpal Tunnel Syndrome

What Is Carpal Tunnel Syndrome?

The carpal tunnel is a tunnel-like structure in the wrist that the median nerve travels through. There are also carpal ligaments that form the roof of the tunnel and flexor tendons that also run through the tunnel. The median nerve is a branch that generates off the brachial plexus from the cervical spine in the neck. It stretches down through the arm, the wrist, and all the way into the thumb. The flexor tendons provide stability and help bend the thumb and fingers. When this nerve is compressed for any reason, it is called Carpal Tunnel Syndrome.

Causes of Medial Nerve Compression

When something causes the tunnel to narrow or the medial nerve somehow becomes compressed in the wrist, this can lead to carpal tunnel syndrome (CTS). CTS can be very uncomfortable.

  • Repetitive motions, like typing,
  • Hypothyroidism, 
  • Obesity, 
  • Rheumatoid arthritis,
  • Diabetes,
  • Pregnancy.

What are the Symptoms of Carpal Tunnel?

The symptoms are pretty telling, including tingling, burning, or numbness in the thumb; muscle weakness in the fleshy area at the base of the thumb; pain or discomfort with movement; shooting pain up the arm, and even trouble sleeping due to the symptoms listed.

Treatment Options for Carpal Tunnel Syndrome

Your doctor will probably first recommend conservative treatments—bracing, changing repetitive positioning, physical therapy, and so on. For pain and swelling, he or she may also recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, though there are dangerous side effects to NSAIDs, such as the risk of heart attack or stroke, GI bleeds, kidney damage, and much more, so it’s best to steer clear of these drugs. Next, your doctor may try steroid injections, which, again, carry many dangerous side effects, such as breaking down cartilage, damaging tendon cells, killing stem cells, and much more.

CTS tends to get worse over time, not better, however, so with traditional orthopedics, the last resort offered will be surgery.

Carpal Tunnel Syndrome Surgery vs. PRP Injections

Surgery for Carpal Tunnel 

Surgery for CTS is called a carpal tunnel release, but in order to release the compressed structures, the surgeon cuts through that ligament that makes up the roof of the carpal tunnel to create more room in the tunnel for the nerve and tendons. So what’s wrong with cutting the ligament?

The ligament is there for a reason, and that is to stabilize the tiny carpal bones in the wrist and to anchor the hand muscles. With that carpal ligament transected, this creates wrist instability and weakness, leaving the wrist vulnerable to arthritis and other wrist and hand problems in the future. We’ve even seen patients with severe postoperative complications following a carpal tunnel release, such as compartment syndrome (while more rare, it is something to be aware of).

PRP for Carpal Tunnel Syndrome

Nerve hydrodissection with platelet lysate for carpal tunnel syndrome doesn’t involve cutting the ligament, nor does it involve open and invasive surgery. Take a look at the video below as Dr. Centeno performs this procedure using ultra high-resolution ultrasound and the tiniest needle made in the U.S.

The platelet lysate contains growth factors concentrated from the patient’s own platelets, and it’s precisely injected around the nerve. In our experience, this frees up the compressed nerve, reduces the inflammation, and improves blood flow to the area—all without harming the delicate biomechanics of the wrist, which is inevitable with carpal tunnel release surgery.  In interventional orthopedics, we also will look for the root cause of the problem. What caused carpal tunnel syndrome to begin with? This may mean tracing that median nerve branch all the way back to an irritated or pinched nerve in the neck and treating that as well.

Carpal tunnel release is an invasive surgery with many consequences. The interventional orthopedics approach to treating the carpal tunnel releases the compressed carpal tissue via a tiny injection that doesn’t include cutting the ligament. And it doesn’t stop there as the primary goal is to figure out what caused the problem in the first place.

Nerve Hydrodissection

Nerve Hydrodissection is a medical procedure that aims to free up scar tissue or adhesions on a given peripheral nerve. The procedure utilizes ultrasound guidance to visualize both the needle and the targeted nerve. Medication is then injected through the needle to free up the scar tissue. Nerve Hydrodissection is a minimally invasive treatment option for many peripheral nerves that are compressed or entrapped by scar tissue.Pain is an uncomfortable and at times painful sensation. It varies significantly from patient to patient. There are many different types of pain which include inflammatory, nociceptive, and neuropathic. Neuropathic pain is pain that arises from nerve compression or injury.

Read More About Nerve Hydrodissection

NSAIDs

The other day I was evaluating a patient and reviewing the treatment options for their spine condition.  After discussing prior treatments, we got to the topic of medications taken for pain relief. She explained that she mainly utilized anti-inflammatory (NSAID) medications and then she told me to hold much she takes and has been for many years…..she takes close to 2 grams (2000 milligrams) on a daily basis which equated to about 9-10 capsules of medication per day.  I was shocked, considering she was pre-diabetic and with high blood pressure plus the kicker of it is that her PCP (primary care physician) is ok with this…

Read More About NSAIDs

Perc-CT SR – Alternative to Carpal Tunnel Surgery

Called the Perc-Carpal Tunnel Scar Release (Perc-CT SR Procedure), and we have been using this carpal tunnel treatment without surgery for many years with excellent results. It’s similar to the standard ultrasound-guided carpal tunnel hydrodissection, but, instead of using the high-dose steroid, which can hurt nerves and tendons (1, 2), we use the patient’s own platelet-derived growth factors that can help nerves repair through cytokines like NGF, PDGF, and IG-1 (3, 4) found in platelet lysate or platelet-rich plasma (PRP). The platelet lysate contains growth factors concentrated from the patient’s own platelets, and it’s precisely injected around the nerve. In our experience…

Read More About Perc-CT SR – Alternative to Carpal Tunnel Surgery

PRP for Carpal Tunnel Syndrome

At the Centeno-Schultz Clinic in South Denver & Broomfield, Colorado, we specialize in treating musculoskeletal and orthopedic problems trying to stimulate the body’s own innate healing system via precise injections. This typically provides, better and longer-lasting results, is safer than drugs and steroids, can prevent many invasive and dangerous surgeries, have much quicker recovery times than surgery. PRP can be used to treat carpal tunnel syndrome. We perform a procedure called hydrodissection. We use ultrasound to guide a very small needle around the median nerve and inject local anesthetic and our specialized PRP called platelet lysate. At the Centeno Schultz Clinic, we have a specialized lab…

Read More About PRP for Carpal Tunnel Syndrome

Steroid Injection for Carpal Tunnel Syndrome

One study compared the five- to six-year outcomes following carpal tunnel surgery in patients who’d had steroid injections to those who hadn’t. They found poorer long-term outcomes (e.g., continuing pain and tingling, waking at night in discomfort, etc.) in those who’d had steroid injections before they had surgery than in those who didn’t have steroid injections before surgery. And, interestingly, the more injections received the higher these risks. In addition, only slightly over half (53%) of patients who received steroid injections reported full resolution of their symptoms five and six years after their surgery. So does this mean you should just skip the steroids from the start and go straight…

Read More About Steroid Injection for Carpal Tunnel Syndrome
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Doctors that Treat Carpal Tunnel Syndrome

Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

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John Schultz, MD

My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Being active is a central part of my life as I enjoy time skiing, biking, hiking, sailing with my family and 9 grandchildren.

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John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

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Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

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Matthew William Hyzy, D.O.

Doctor Hyzy is Board Certified in Physical Medicine and Rehabilitation (Physiatry) and fellowship-trained in Interventional Orthopedics and Spine. Dr. Hyzy is also clinical faculty at the University of Colorado School of Medicine in the Department of Physical Medicine and Rehabilitation; In addition, Dr. Hyzy is an Adjunct Clinical Assistant Professor at The Rocky Vista University College of Osteopathic Medicine. Dr. Hyzy also maintains an active hospital-based practice at Swedish Medical Center and Sky Ridge Medical Center. He is also recognized and qualified as an expert physician witness for medical-legal cases and Life Care Planning. He is published in the use of autologous solutions including…

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Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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Mairin Jerome, MD

Mairin Jerome, MD

Dr. Mairin Jerome is a physiatrist with subspecialty fellowship training in Interventional Orthopedics and Regenerative Medicine. This subspecialty serves to fill the gap for patients who are interested in therapeutic options that lie between conservative treatment and surgery. Dr. Jerome uses regenerative medicine techniques, including prolotherapy and orthobiologics, via X-ray or ultrasound guidance to precisely deliver injections to areas of musculoskeletal injury or degeneration. Orthobiologics refers to tissue harvested typically from a person’s own body, such as platelets (platelet-rich plasma, PRP) or bone marrow, for use in treating painful musculoskeletal conditions. The goal is to stimulate the body’s healing mechanisms to improve pain, function, and decrease inflammation.

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More Resources for CTS

  • Tendonitis vs Carpal Tunnel: Identifying Important Differences

    Tendonitis and carpal tunnel syndrome are two distinct clinical conditions that affect the wrist and hand. Dr. Schultz discusses what tendonitis and carpal tunnel syndrome are, the major causes, common symptoms, treatment options, and the important difference between the two.


  • Numbness after Carpal Tunnel Surgery: 5 Causes That You Need Know

    Carpal Tunnel Syndrome is a medical condition that causes pain and numbness in the hand and fingers. It arises from compression of the median nerve. Dr. Schultz discusses the 5 major causes of numbness after Carpal Tunnel Surgery, their causes, and a novel, nonsurgical treatment option for carpal tunnel syndrome.


  • Carpal Tunnel Surgery Recovery: Facts You Need to Know Now!

    Carpal tunnel syndrome (CTS) is a painful wrist and hand condition that occurs due to compression of the median nerve. Carpal tunnel surgery releases the pressure on the median nerve through different surgical techniques. Dr. Schultz discusses carpal tunnel surgery recovery, complications and a new nonsurgical alternative for those with carpal tunnel syndrome.


  • Are Migraines and Carpal Tunnel Syndrome Related?

    Millions of people suffer from carpal tunnel syndrome, and carpal tunnel release is one of the most common surgeries performed today. Millions also struggle with chronic migraines. While we know carpal tunnel syndrome is a compression condition, there is also recent evidence that migraines, not historically thought to be a compression issue, may be associated … Continued


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