Monthly Archives: March 2015

Overview of Carpal Tunnel Syndrome

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Carpal Tunnel syndrome occurs when the median nerve leading from the forearm into the palm of the hand becomes compressed. This nerve is carried through the carpal tunnel, which is a narrow, rigid passageway made up of bones and ligaments and located at the base of the hand. In some individuals, there may be a genetic pre-disposition to a smaller carpal tunnel. In other instances, the tunnel may become narrowed by injury or a thickening of tendons or other swelling. Carpal Tunnels syndrome can also be associated with underlying diabetes and arthritis.

Symptoms usually start gradually and build over a period of time. There may be tingling and/or numbness in the hand, wrist or fingers. As the symptoms worsen, shooting pain can be felt in the hand or even up the affected arm. The problem may be noticed initially in the morning upon wakening; many people sleep with their wrists flexed, and this may exacerbate the condition.

As with other conditions, early intervention will allow for the best use of minimally-invasive techniques to ameliorate the condition. Consult early with a Board Certified doctor who specializes in treating the hand and arm. Initially, the doctor will conduct tests to rule out the underlying conditions of diabetes or arthritis. Non-steroidal anti-inflammatory drugs may be prescribed, to lessen the swelling and pain. A period of rest may be required, and a splint may be used to immobilize the wrist and allow it to heal. Later in treatment, exercises may be employed to foster range of motion, build strength and reduce pain and swelling.

If these techniques and time do not control the condition, surgery may be required. A special hand surgeon, such as Dr. Rehman, performs this surgery using minimally invasive techniques and specialized endoscopic instruments. The special scope allows the surgeon to see the tissue and the ligaments inside the hand, and make the necessary adjustments using tiny instruments. This type of minimally-invasive Carpal Tunnel surgery usually results in minimal scarring and tenderness, and a quicker recovery time than traditional Open Release surgery.

If you are experiencing symptoms of carpal tunnel syndrome, consult with Dr. Rehman early for the greatest chance of success using the least invasive procedures.

Do I Need a Cortisone Injection?

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Although not technically a pain-relieving medication, injectable corticosteroids, commonly called ‘Cortisone”, have been used since the 1950’s to reduce pain following a muscle or tendon injury. Cortisone is naturally produced in the body by the adrenal gland and is released when the body is under stress. Injectable cortisone is synthetically produced and is similar to the body’s own product. By reducing the body’s reaction to the inflammation associated with the injury, the pain is reduced.

The medicine is injected directly into the inflamed area, such as the wrist or elbow, with a high concentration of cortisone administered with minimal side effects. Discomfort usually improves within a few days and can last for several weeks or permanently. However, cortisone injections must be coupled with appropriate rest and rehabilitation to produce the best results. Cortisone injections are contraindicated for athletes immediately before an event, as they may increase the risk of infection or contribute to additional injury.

Repeated injections can have deleterious side effects, with a softening of the cartilage and weakening of the tendons at the injection site, however this usually occurs only in patients who receive shots on a weekly or monthly basis over a period of months or even years. Diabetic patients must have their blood sugar monitored closely for 24 to 48 hours after an injection, since the absorption of cortisone into the blood stream can cause a significant elevation in blood sugar.

Most individuals tolerate the procedure well, and find significant relief from the pain of a muscle or ligament injury. Always seek a Board Certified orthopedic doctor such as Dr. Rehman for any type of hand or arm injury. And don’t wait to seek treatment! A hand or arm injury that is causing pain should be evaluated early on, when the chance for minimally invasive treatment leading to a full recovery is at its highest.