Carpal Tunnel Syndrome Treatment

Carpal tunnel syndrome (CTS) is one of the most common neurological disorders. It affects 1 to 5% of the population worldwide. Please continue reading to learn more about this condition and how to have carpal tunnel syndrome treated.

What causes carpal tunnel syndrome?

The carpal tunnel is a narrow passageway in the wrist that is surrounded by bones and ligaments. The median nerve travels through this tunnel. This nerve provides sensation to the palm side of the thumb, index finger, middle finger, and ring finger (all the fingers except the little finger). The median nerve can become entrapped or compressed in the carpal tunnel area. A compressed median nerve can cause carpal tunnel symptoms.

Known risk factors for carpal tunnel syndrome include:

Anatomic abnormalities: Changes in the wrist anatomy, for example, due to a wrist fracture or arthritis, can narrow the carpal tunnel and place pressure on the median nerve.
Gender: Females have a 3 times higher risk of developing carpal tunnel syndrome than males. This is believed to be because of the smaller size of the carpal bones (wrist bones) and smaller carpal tunnels in females.
Health conditions: A medical history of diabetes or rheumatoid arthritis can increase your risk of carpal tunnel syndrome. Diabetes can damage the nerves and arthritis can cause inflammation of the tendons around the median nerve. Other medical conditions that can also increase CTS risk include thyroid disorders, kidney failure, lymphedema, menopause, and obesity.
Work environment: The use of vibrating tools or repetitive flexing of the wrist, for example, during assembly line work or on a computer keyboard, can put pressure on the median nerve and cause carpal tunnel syndrome. Frequent breaks can help limit nerve damage.

What are carpal tunnel syndrome symptoms?

Early symptoms of carpal tunnel syndrome include wrist pain and a numbness or tingling sensation, especially in the thumb, index, and middle fingers. The symptoms can be present in one or both hands--CTS may feel like electrical activity or mild shocks and the numbness and tingling can travel from the wrist up the arm. It may be brought on by holding things like a car steering wheel or newspaper. Nighttime symptoms of carpal tunnel syndrome can wake you from sleep.

Initially, you may be able to relieve symptoms by shaking out your hands. But over time, more severe symptoms of carpal tunnel syndrome typically develop, resulting in constant numbness. People with advanced stages of carpal tunnel syndrome can develop weakness in the hand muscles due to the median nerve compression. This can make it difficult to open jars or cause a person to drop things.

Will carpal tunnel go away on its own?

Once carpal tunnel syndrome develops, it is unlikely to go away on its own without treatment. There are nonsurgical treatments available for carpal tunnel syndrome. In addition, orthopedic surgeons can perform carpal tunnel syndrome surgery.

How is carpal tunnel syndrome diagnosed?

It’s important to have carpal tunnel syndrome diagnosed early. Your doctor will ask you about your symptoms and perform a physical examination to check for hand pain, grip strength weakness, wrist flexion test, limited wrist motion, and signs of nerve damage. They may tap or press on the median nerve to see if it causes numbness and tingling. If your doctor suspects CTS, they may order additional tests, such as:

Nerve conduction studies. A nerve conduction study checks how quickly electrical impulses travel in the nerves of the hand and whether there is any damage to the median nerve.
Electromyogram (EMG). This test measures electrical activity in the muscles of the hand to check for muscle damage.
X-rays or other imaging tests. Your doctor may order these to rule out other causes of your symptoms.

What is the best treatment for carpal tunnel syndrome (median nerve entrapment or compression)?

Simple lifestyle measures can be used to treat carpal tunnel syndrome in the early stages. These include

Taking more frequent rest breaks to keep the wrist straight and relax the wrist position periodically.
Avoiding activities that make carpal tunnel syndrome symptoms worse.
Using cold packs to reduce swelling and pain.

This treatment plan typically works in people who have had mild to moderate symptoms for less than 10 months, and their symptoms come and go.

Non-Surgical Treatments for Carpal Tunnel Syndrome

Other treatments may be necessary for more severe cases of carpal tunnel syndrome, such as:

Wrist splint: Wearing a wrist splint at night can help relieve nighttime tingling and numbness as well as reduce CTS symptoms during the daytime. This is a good option if you want a non-medication treatment, for example, if you’re pregnant.
Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications (for example, ibuprofen) can help reduce pain from carpal tunnel syndrome. However, these drugs do not address the underlying cause of carpal tunnel syndrome.
Corticosteroid injections: Injections of steroid medicine can be done to relieve CTS symptoms. Your doctor may perform the injections using ultrasound guidance to place the medicine precisely in the carpal tunnel space. Corticosteroids reduce swelling and inflammation and relieve pressure on the median nerve. Oral corticosteroids are not as effective for carpal tunnel syndrome.
Nerve gliding exercises: A physical or occupational therapy specialist can teach you stretching and nerve gliding exercises that are beneficial in treating carpal tunnel syndrome.

Carpal Tunnel Syndrome Surgery

Your doctor may recommend a surgical procedure for carpal tunnel syndrome if your symptoms are severe and you have not responded to conservative treatments. The following surgical procedures can be done using local anesthesia to relieve pressure on the median nerve.

Endoscopic carpal tunnel release: This procedure is done using an endoscope (a long, thin device with a camera attached to it). It allows the surgeon to see the carpal tunnel and cut the ligament or connective tissue that is putting pressure on the median nerve. A minimally invasive endoscopic surgery causes less pain, and recovery is faster than open surgery.
Open carpal tunnel surgery: This surgery involves making an incision in the palm over the carpal tunnel area and cutting the transverse carpal ligament to free the median nerve and relieve pain from carpal tunnel syndrome.

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