Carpal Tunnel Syndrome (CTS) is a prevalent and often debilitating condition that affects countless individuals, causing pain, tingling, and weakness in the hand and wrist. While many individuals may initially turn to their primary care physicians or orthopedic specialists for treatment, there are compelling reasons to consider consulting a neurologist when dealing with CTS. In this blog post, we’ll explore why seeing a neurologist for Carpal Tunnel Syndrome can be a wise choice.
What is carpal tunnel syndrome?
Before looking into why one should see a neurologist for carpal tunnel treatment, it is important to first understand carpal tunnel syndrome. Carpal Tunnel Syndrome (CTS) is a common medical condition that affects the hand and wrist. It occurs when the median nerve, which runs from the forearm into the hand, becomes compressed or irritated as it passes through a narrow passageway in the wrist called the carpal tunnel.
The carpal tunnel is a small, rigid structure formed by the bones of the wrist and a ligament that covers the top. This compression or irritation of the median nerve can lead to a range of symptoms, including:
- Pain: Individuals with CTS often experience pain in the hand and wrist, which can sometimes radiate up the arm.
- Numbness and Tingling: Numbness and tingling sensations, often described as “pins and needles,” are common symptoms. These sensations typically affect the thumb, index finger, middle finger, and a portion of the ring finger.
- Weakness: Weakness in the hand and a decreased ability to grip objects can occur due to the nerve compression.
- Atrophy: In severe cases or if left untreated, CTS can lead to muscle atrophy, causing the affected hand to appear thinner or weaker than the unaffected hand.
- Symptoms at Night: Many people with CTS experience symptoms, particularly pain and numbness, at night, which may disrupt sleep.
The exact cause of Carpal Tunnel Syndrome can vary, but it is often related to factors such as repetitive hand and wrist movements, underlying medical conditions (e.g., diabetes, rheumatoid arthritis), pregnancy, or anatomical factors that make the carpal tunnel narrower than usual. Early diagnosis and appropriate treatment are crucial to manage CTS effectively and prevent complications. Treatment options range from conservative measures like wrist splints and physical therapy to more invasive interventions, including surgery in severe cases.
Why to See a Neurologist
Consulting a neurologist for Carpal Tunnel Syndrome (CTS) treatment can be advantageous for several reasons:
Expertise in Nerve Disorders:
Neurologists are medical specialists who focus on disorders of the nervous system, which includes the peripheral nerves. Since CTS primarily involves compression of the median nerve in the wrist, neurologists are experts in diagnosing and treating nerve-related conditions. Their specialized knowledge of the nervous system makes them well-suited to address the complexities of CTS.
Proper diagnosis is essential for effective CTS treatment. Neurologists have access to advanced diagnostic tools and tests, such as nerve conduction studies and electromyography (EMG), which can accurately confirm the diagnosis of Carpal Tunnel Syndrome. These tests provide valuable information about the extent of nerve damage, allowing for tailored treatment plans.
CTS can sometimes be a symptom of underlying medical conditions, such as diabetes, rheumatoid arthritis, or thyroid disorders. Neurologists are skilled at conducting comprehensive evaluations to identify any contributing factors or associated health issues. Addressing these underlying conditions is crucial for managing CTS effectively and preventing its recurrence.
Various Treatment Options:
Neurologists can offer a range of non-surgical treatment options to manage symptoms and improve patients’ quality of life. In cases where conservative treatments fail to provide relief, surgery may be necessary to release pressure on the median nerve. Neurologists with expertise in nerve and hand surgery can perform procedures like carpal tunnel release surgery with precision. They can discuss the risks and benefits of surgery and guide patients through the recovery process.
Ongoing Monitoring and Follow-Up:
Neurologists are skilled at monitoring the progress of CTS treatment over time. They can adjust treatment plans as needed and provide ongoing support to patients. Regular follow-up appointments with a neurologist can help ensure that the condition is managed effectively and that any complications are addressed promptly.
How Neurologists Treat Carpal Tunnel Syndrome
Neurologists can offer a range of treatments for Carpal Tunnel Syndrome (CTS), depending on the severity of the condition and individual patient needs. Here are some common treatments that neurologists may recommend:
Conservative (Non-Surgical) Treatments:
- Wrist Splints: Customized wrist splints are often prescribed to keep the wrist in a neutral position, preventing excessive flexion or extension that can exacerbate CTS symptoms. Wearing a splint, especially at night, can help alleviate pressure on the median nerve.
- Physical Therapy: Neurologists may refer patients to physical therapists who specialize in hand and wrist rehabilitation. Physical therapy exercises can improve hand strength, flexibility, and posture, reducing CTS symptoms.
- Medications: Neurologists may prescribe non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids to reduce pain and inflammation associated with CTS. Neurologists can monitor the use of medications and adjust dosages or types of medication as needed to manage pain and inflammation effectively.
- Nerve Gliding Exercises: These exercises are designed to gently move and glide the affected median nerve to reduce compression within the carpal tunnel. Physical therapists often teach these exercises to patients.
Occupational and Lifestyle Modifications:
Neurologists can provide guidance on making ergonomic changes in the workplace or at home to reduce strain on the wrist and hand. This may include adjusting workstation setups, using ergonomic tools, and practicing proper hand and wrist posture during tasks.
Neurologists can advise on modifying activities that may exacerbate CTS symptoms, especially those involving repetitive hand and wrist movements. Reducing or avoiding such activities can help alleviate pressure on the median nerve.
Bracing and Support:
In addition to wrist splints, neurologists may recommend other supportive devices, such as ergonomic keyboards, mouse pads, or padded gloves, to minimize wrist and hand strain during daily tasks.
For individuals with moderate to severe CTS symptoms, neurologists can administer corticosteroid injections directly into the carpal tunnel to reduce inflammation and alleviate symptoms. Neurologists are also able to use neuromuscular ultrasound technology to ensure accuracy and avoid damage to the median nerve while performing corticosteroid injections.
Nerve Conduction Studies (NCS) and Electromyography (EMG):
Neurologists can use nerve conduction studies (NCS) and electromyography (EMG) to assess the extent of nerve damage and the severity of CTS. This information helps guide treatment decisions.
In cases where conservative treatments do not provide relief or when CTS is severe, neurologists with surgical expertise can perform carpal tunnel release surgery. This procedure involves cutting the ligament that forms the roof of the carpal tunnel to relieve pressure on the median nerve.
It’s important to note that the choice of treatment depends on individual factors, including the severity of symptoms, the duration of the condition, and the presence of underlying medical conditions. A neurologist will conduct a comprehensive evaluation to determine the most appropriate treatment plan for each patient’s unique circumstances.
Carpal Tunnel Syndrome can significantly impact an individual’s daily life, causing pain, numbness, and weakness in the hand and wrist. While various healthcare providers can offer treatment for CTS, consulting a neurologist can provide several advantages, including specialized expertise in nerve disorders, precise diagnosis, comprehensive evaluation, non-surgical treatment options, ongoing monitoring, and surgical expertise if needed. If you or someone you know is experiencing symptoms of Carpal Tunnel Syndrome, considering a consultation with a neurologist may be a crucial step toward effective management and improved quality of life.
Dr. Kashouty, a diplomate of the American Board of Psychiatry and Neurology (ABPN), practices general neurology with fellowship trained specialization in clinical neurophysiology. Dr. Kashouty finds the form and function of the nerves and muscles the most interesting part of neurology, which is what led him to specialize in neurophysiology with more emphasis on neuromuscular conditions. He treats all neurological diseases, but his main focus is to treat and manage headaches, movement disorders and neuromuscular diseases.