Intraneural Facilitation as a Treatment for Carpal Tunnel Syndrome

INF is a novel non-invasive therapy based on the principle of restoring vascular function at the capillary level in peripheral nerve. his therapy has been shown to improve clinical function in patients with diabetic-associated polyneuropathy, a model for various forms of ischemic neuropathy. CTS is a common condition where regional compression at the wrist results in ischemic focal demyelination of the distal median nerve. This results in sensory dysfunction, pain, and eventually axon loss and weakness if the compression is sufficiently severe and prolonged. Standard therapy for CTS includes wrist splints, regional lidocaine injections, ergonomic adjustments, various forms of occupation therapy, and ultimately surgical release of the carpal tunnel ligament. However, all of these are either temporary in their effect or invasive. The diagnosis of CTS relies on clinical, electrodiagnostic or NCS, and ultrasound methods.

Inclusion criteria

• Patients referred to the LLUH Neurology Electrodiagnostic Laboratory with electrodiagnostic and clinical evidence of CTS (uni- or bilateral)
• Ages >18 and < 75 (irrespective of gender)
• Current use of splints as long as the frequency of treatment is unaltered and onset of use is > 1 week in duration

Exclusion criteria

• Prior carpal tunnel release > 2 years ago
• The presence of any condition that would prevent NCS from accurately diagnosing CTS (e.g., hereditary polyneuropathy or acquired demyelinating polyneuropathy)
• Workman's Compensation cases
• Pregnancy
• Undergoing conservative or surgical/injection therapy (physical or occupational therapy, injections)
• Clinically silent CTS in face of positive electrodiagnostic results
• Sufficiently severe clinical symptoms that warrant more aggressive therapy i.e., carpal injections or release
• Any confounding medical condition that the investigator deems may adversely affect subject participation or outcomes