How Carpal Tunnel Syndrome Is Treated

Treatment of carpal tunnel syndrome depends on the type and duration of symptoms. It usually will begin with conservative treatments using a wrist splint and you may get a corticosteroid injection to reduce the inflammation. If this does not provide relief or if your symptoms are severe, carpal tunnel release surgery is an option.

Over-the-Counter Therapies

Wearing a splint or brace at night is usually the first form of treatment. You can find wrist splints at the drugstore in a variety of sizes. A rigid splint that aligns your wrist in a neutral position is best. You can also find more flexible splints that may be appropriate for daytime use.

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen can help relieve the pain symptoms. However, these drugs won't improve the condition itself.

Home Remedies and Lifestyle

You can apply cold packs to your wrist to help reduce swelling. It is also wise to avoid activities that make your symptoms worse. Take frequent breaks to rest your hands during any activity that requires flexing the wrists. Avoid sleeping on your hands, especially with your wrists bent.

Prescriptions

Your healthcare provider may prescribe a custom splint constructed by an occupational therapist that will fit you precisely. Oral corticosteroids might be prescribed to reduce the inflammation and swelling. However, a cortisone injection is more likely.

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Surgeries and Procedures

Further treatment will depend on the severity of your symptoms if they have not responded to conservative treatment. You may be referred to a neurologist or orthopedic surgeon.

Cortisone Injection

Cortisone injections, sometimes guided by endoscopy, have long been used as a treatment for carpal tunnel syndrome. While there are potential side effects, they are generally considered safer than surgery.

Sometimes a cortisone injection is given to help confirm the diagnosis of CTS, which should be at least temporarily relieved by the injection. Symptoms due to a different cause wouldn't be relieved by injection at this site.

Hand Therapy

Your healthcare provider may refer you to a hand therapist as a conservative treatment or during recovery from surgery. A therapist may teach you nerve gliding and tendon gliding exercises. These are hand motions aimed to keep the nerves and tendons sliding smoothly through the carpal tunnel. A hand therapist may also use iontophoresis to administer steroids through the skin. Therapeutic ultrasound may also decrease pain and numbness.

Carpal Tunnel Release Surgery

Carpal tunnel release surgery is the next step if the symptoms are severe or if they haven't responded to conservative treatment. It is an outpatient day surgery done under local or regional anesthetic, so you would go home the same day. However, you may have sedation and thus would need someone else to drive you home. If you need to have surgery on both hands, it may be performed at the same time.

In carpal tunnel surgery, the ligament around the wrist is cut to relieve the pressure on the median nerve. You will usually feel a relief of your symptoms immediately. The ligaments grow back together and provide more space in the carpal tunnel for the nerve. The surgery can be done in two ways:

• Open release surgery is done by making an incision with a scalpel in the wrist and cutting the ligament.
• Endoscopic surgery uses one or two small incisions in the wrist and palm to insert a camera attached to a tube. The ligament is cut with a tiny knife inserted through the tube.

After surgery, you will likely be advised to wear wrist splint or brace for several weeks. You may have to adjust your work duties while you are recovering and get help with chores, but you should soon be able to drive and do light lifting.

Full recovery after surgery can take a few months, during which you'll have some reduced grip strength. This will usually return within two to three months but can take up to a year in cases where the nerve impingement was severe. Only about half of those who have carpal tunnel release surgery have full restoration of normal use and sensation. It is common to have some numbness or weakness after recovery. While there is always risk to surgery, the good news is that a recurrence of the problem is rare. You may be referred to a hand therapist to help with recovery if you are still having pain and weakness after two months.

Complementary Medicine (CAM)

A review of studies in 2010 reported on limited evidence that some alternative therapies may be helpful for CTS:

• Yoga can help strengthen your upper body and improve your grip strength. It is noted as being helpful by the NIH National Institute of Neurological Disorders and Stroke. However, there has not been a controlled study to support using yoga in the past 20 years.
• Acupuncture was supported as an adjunct therapy or alternative by an NIH consensus statement in 1997. A variety of studies have not shown conclusive evidence that is effective. Needle acupuncture, acupressure, or laser acupuncture may be performed by alternative therapy practitioners. Low-level laser therapy may also be done along the median nerve rather than at acupuncture sites. The evidence of its effectiveness is likewise mixed.
• Magnetic field therapy has also had few studies, with the most recent one showing no effect.

Some practitioners recommend these alternative therapies, although there are limited or no studies of their use:

• Chiropractic care may include manipulation of the soft tissues and body joints of the arms and spine, trigger point therapy, ultrasound over the carpal tunnel, and the usual conservative care of night-time wrist supports. Practitioners say chiropractic care can be helpful in alleviating ongoing issues stemming from the neck and shoulders as well as the wrist.
• Feldenkrais is a form of movement re-education. It is aimed at improving coordination, reducing joint stress, and improved flexibility.
• Hellerwork is a type of bodywork that includes deep tissue work around the forearm and wrist, education about posture and movement, and dialogue about emotions that can affect your muscles and breathing.
• Supplements: Vitamin B6 is suggested as a supplement to help with pain relief. However, precautions are needed because high doses can result in nerve damage. Alpha-lipoic acid (ALA) is an antioxidant that has been suggested by some alternative practitioners for CTS. Enzyme supplements such as serrapeptase, bromelain, and papain are proposed by some alternative practitioners on the theory that they might reduce tissue swelling. Discuss any supplements with your healthcare provider as they may not be appropriate for pregnant women, nursing mothers, children, or those with other medical conditions. They may also interact with other medications.