Carpal tunnel syndrome is the most common pinched-nerve condition. You are about to learn the most common cause of carpal tunnel syndrome and how to successfully treat it without surgery.

The median nerve supplies all the small muscles on the thumb side of the hand. Also, the median nerve provides sensation to the thumb, index finger, middle finger and half of the ring finger.

There is a ligament that goes across the wrist called the flexor retinaculum, which forms a tunnel over the wrist bones. Carpus is the Latin word for wrist, hence the name carpal tunnel syndrome. In this tunnel, nine tendons (one to the thumb and two to each of the other fingers) travel with the median nerve. Any condition that causes swelling in the carpal tunnel will cause pressure on the median nerve. This can cause pain in the area of the hand that is supplied by the median nerve, especially those three fingers mentioned above. If the pressure on the nerve is severe and long-lasting, sensation is diminished and even weakness can develop.

The most common cause of swelling in the carpal tunnel is the tendons becoming irritated from overuse, especially with repetitive motion. For instance, typing or working with machinery will strain these tendons. When the tendons are strained, they tend to swell, and that creates the pressure in the carpal tunnel which can irritate or even damage the median nerve. When the ligaments in the wrist are weak, that creates a low-grade instability. The tendons will have to work harder, further contributing to their overuse and strain.

A very common treatment for carpal tunnel syndrome is a surgical release of the flexor retinaculum. This creates more room for the tendon and nerve, which reduces the symptoms. While results are generally good, there are two problems with this. One is that scarring can develop, which will cause recurrent nerve compression and the symptoms to come back. The other problem is that it is not treating the true cause of the problem, which is the tendonitis and the mechanical problems that led to that tendonitis.

It makes more sense to treat the tendons, treat the ligaments and release the nerve in a gentle way without surgery. With this three-pronged approach to carpal tunnel syndrome, the symptoms improve and the tendonitis is resolved for long-term healing. Without any surgical incisions, there is no concern that any scar tissue will develop.

Neural prolotherapy is a great treatment for tendons and nerves. It involves the use of low concentrate dextrose (5%) put just under the skin along the path of the nerve being treated and at the tender points within the tendons. Because it is superficial, it is well tolerated; and because it addresses both the tendon and the nerve, it is a comprehensive treatment for carpal tunnel syndrome.

Pain is generated by small nerve fibers. It was found that when these fibers are lacking glucose, they generate pain signals. When providing glucose using 5% dextrose, that stops the nerve from firing and the pain subsides. What is amazing to watch is that by placing 5% dextrose at several spots along the nerve, the carpal tunnel pain subsides instantly and dramatically. By restoring the internal environment of the nerve cell, pain is extinguished.

As noted, when there are lax ligaments across the wrist, the tendons that cross the wrist have to work harder. The ligaments can be strengthened with prolotherapy. This involves using a higher concentration of dextrose (15-25%) around the ligaments across the wrist. This creates a mild irritation of those ligaments with resulting increased blood flow to the ligaments.

This is important because ligaments and tendons do not get ample blood flow. With prolotherapy, increased blood flow to the ligaments helps growth factors migrate to the area. This results in strengthening of the ligaments with improvement of the ligament laxity. With stronger ligaments, the wrist becomes more stable and the tendons have less strain on an ongoing basis, so the pain relief is long-lasting.

We have now treated the tendons and the ligaments. Lastly, we free the nerve in a natural way that does not involve surgery. This is done by a technique called hydrodissection. This is performed with ultrasound guidance. The median nerve is isolated and fluid (saline or anesthetic) is instilled around the nerve. The pressure of the fluid frees the nerve from its tight connections to the surrounding tissue. Thus, the nerve has more space and is looser. When looser, the nerve is less susceptible to compression by the surrounding tendons with the carpal tunnel.

To summarize, we treat the tendons and the median nerve with superficial dextrose. This nourishes the nerve, thereby reducing its pain signals and improving the health of the tendons. When the tendons are healthy, their swelling is reduced and that takes pressure off the nerve.

By treating the ligaments with prolotherapy, the wrist becomes more stable. That reduces the strain on the tendons, so the tendons stay healthy for long-term healing.

Lastly, by freeing the nerve with hydrodissection, the nerve becomes looser and will be less susceptible to compression within the carpal tunnel. With this approach, you can avoid surgery and at the same time have a long-term solution to your carpal tunnel syndrome.

Dr. Slaten is a pain wellness physician in Ridgewood, New Jersey. For more than 20 years, he has been practicing regenerative techniques with great skill and an open mind. Check out his website at www.njprolo.com.