The median nerve (middle nerve) runs through the carpal tunnel. It controls hand muscles via branches and provides sensation in the first three fingers. Compression of this nerve can cause tingling and numbness, and ultimately muscle weakness and atrophy.
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There are many causes, but it usually occurs spontaneously. (1)
Treatment
The treatment consists of an injection of an anti-inflammatory (corticosteroid) into the carpal tunnel. This causes the tendons and the nerve in the tunnel to swell, so that the nerve is less compressed. This treatment is safe and effective. (2)
Results can be expected between three days and a week after the injection. The improvement can continue after that.
An injection often helps in the short term. In the long term, multiple injections may be necessary. (3) Follow-up injections usually help just as well. (4)
Alternative to corticosteroids
For people who cannot tolerate corticosteroids, we have a good alternative: an injection with procaine. This is a local anesthetic that briefly numbs the nerve and dampens excessive stimulation of the nerve. (5)
If the complaints do not respond to treatment
If the complaints do not respond to the usual therapy, there is a good chance that the nerve compression is not the cause of your complaints. Tingling, pain or numbness in the hand may radiate from the elbow, shoulder or neck. So the problem is not always in the wrist. We try to find this out during our investigation, and if we find it, we will deal with it immediately.
Recognizable symptoms
- Tingling in the hand
- A numb feeling in the thumb, index finger and middle finger
- Pain in the hand
- Loss of strength in the hand muscles
- Complaints that radiate from the elbow, shoulder or neck
Scientific references (8)
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- Chesterton LS, Blagojevic-Bucknall M, Burton C, Dziedzic KS, Davenport G, Jowett SM, Myers HL, Oppong R, Rathod-Mistry T, van der Windt DA, Hay EM, Roddy E. The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome (INSTINCTS trial): an open-label, parallel group, randomised controlled trial. Lancet. 2018 Oct 20;392(10156):1423-1433. doi: 10.1016/S0140-6736(18)31572-1. PubMed PMID: 30343858; PubMed Central PMCID: PMC6196880.
- Maddison PJ, Isenberg DA, Woo P, et al: eds. Oxford Textbook of Rheumatology. ed 2. New York: Oxford University Press; 1998,vol 2:pp 1507
- Racasan O, Dubert T: The safest location for steroid injection in the treatment of carpal tunnel syndrome. J Hand Surg (Br) 2005;30:412-4
- Huisstede BM, Fridén J, Coert JH, Hoogvliet P; European HANDGUIDE Group. Carpal tunnel syndrome: hand surgeons, hand therapists, and physical medicine and rehabilitation physicians agree on a multidisciplinary treatment guideline—results from the European HANDGUIDE Study. Arch Phys Med Rehabil. 2014 Dec;95(12):2253-63.
- Ashworth NL, Bland JD. Effectiveness of second corticosteroid injections for carpal tunnel syndrome. Muscle Nerve. 2013 Jul;48(1):122-6
- Karadaş O, Tok F, Ulaş UH, Odabaşi Z. The effectiveness of triamcinolone acetonide vs. procaine hydrochloride injection in the management of carpal tunnel syndrome: a double-blind randomized clinical trial. Am J Phys Med Rehabil. 2011 Apr;90(4):287-92.
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- Wu YT, Ho TY, Chou YC, Ke MJ, Li TY, Tsai CK, Chen LC. Six-month Efficacy of Perineural Dextrose for Carpal Tunnel Syndrome: A Prospective, Randomized, Double-Blind, Controlled Trial. Mayo Clin Proc. 2017 Aug;92(8):1179-1189. doi: 10.1016/j.mayocp.2017.05.025. PubMed PMID: 28778254.
