Carpal Tunnel Syndrome Treatment

Definition:

Carpal tunnel syndrome is a progressively painful hand and arm condition caused by a pinched nerve in your wrist.

Bound by bones and hand ligaments, the carpal tunnel is a narrow passageway located on the palmar side of the wrist. This tunnel protects a main nerve to your hand and tendons to your fingers. Compression of the nerve produces the numbness, pain and, eventually, hand weakness that characterize carpal tunnel syndrome.

Early and proper treatment can relieve the pain and numbness and restore normal use of their wrists and hands.

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome is the most common nerve constriction causing numbness in the hands. It is caused by excessive pressure on the median nerve as it goes across the wrist into the hand. This nerve is the main nerve providing sensation in the hand and control of the thumb muscles. Along with the flexor tendons to the fingers, this nerve goes through a tunnel at the wrist, consisting of the wrist bones and a thick band of fibrous tissue across the top.

Any increase in the pressure within this space will decrease blood flow to the median nerve, affecting its function and causing numbness, tingling, and burning pain in the hand. Out of every 1000 people, 3-5 will develop carpal tunnel syndrome in their lifetime.

What are the Symptoms?

The typical history of carpal tunnel syndrome starts with night symptoms of tingling, pain and numbness in the hand, often on both sides. It may wake the patient up at night and the patients finds relief in shaking his or her hands for the numbness to go away.

Symptoms most often occur in the thumb, index finger, middle finger, and half of the ring finger. It can progress to having the same symptoms during the day and eventually, to having constant numbness and paranesthesia. Weakness of thumb muscles develops in the later stages of the problem

How Do I Know I Have it?

If you have numbness, tingling or burning pain in the thumb, index, middle or ring fingers you may have carpal tunnel syndrome. These symptoms usually are worse in the morning after waking up and may sometimes wake you up from sleep.

Gripping an object tightly, using a mobile phone or holding up a newspaper can also trigger these symptoms. Tingling, pain, and stiffness are worse when the hands are cold and better when warm. Shaking the hands vigorously usually relieves the symptoms. Over time, the ability to feel becomes worse. It may feel as if there is a layer between the skin and the object making it harder to feel it properly. The thumb muscles may become weak and waste away, resulting in difficulty performing simple tasks like doing up buttons or picking up coins.

It is important to see a hand surgeon to get the right diagnosis and treatment if you have numbness or tingling in the hands. Your hand surgeon may order a nerve conduction study, ultrasound scan or MRI of the hand to help confirm the diagnosis.

Other nerve compressions can cause numbness or pain in the hands, such as cubital tunnel syndrome (ulnar nerve compression at the elbow) and pronator tunnel syndrome (median nerve compression in the forearm). These less common conditions may be misdiagnosed as carpal tunnel syndrome resulting in the wrong treatment.

When to See a Doctor?

If you have persistent signs and symptoms suggestive of carpal tunnel syndrome, especially if they interfere with your normal activities and sleep patterns, see your doctor. If you leave the condition untreated, nerve and muscle damage can occur.

Some people with mild symptoms of carpal tunnel syndrome can ease their discomfort by avoiding extreme bending or extending the wrist during sleep. Normal activities that involve a lot of repetitive wrist motion should also be avoided. If these techniques don’t offer relief within a few weeks, additional treatment options include wrist splinting, medications and surgery. Splinting and other conservative treatments are more likely to help you if you’ve had only mild to moderate symptoms for less than 10 months.

What Causes Carpal Tunnel Syndrome?

The pressure in this tunnel increases as we grow older due to thickening of the tendons from repeated daily use. Other conditions such as wrist fractures, gout, or tumours may also increase the pressure in this tunnel. The increased pressure decreases blood flow to the nerve, impairing its function.

Carpal tunnel syndrome is also commonly associated with frequent repetitive work using the hands for long hours. Production line workers and homemakers, and those who work long hours at the computer keyboard with poor posture are at greater risk.

Pregnant women are also susceptible due to water retention. It is also more common among people with diabetes, renal failure, hypothyroidism, and rheumatoid arthritis.

How is Carpal Tunnel Syndrome Treated?

Conservative Treatment

Early or mild carpal tunnel syndrome can be treated by keeping the wrist in a brace especially when sleeping and avoiding postures and activities that increase the pressure around the nerve. Non-steroidal anti-inflammatory medication, high dose Vitamin B6 and steroid injections around the nerve may also provide temporary relief. Special “nerve gliding” exercises done several times a day can help loosen the median nerve in the carpal tunnel.

Conservative treatment is often effective in early and mild carpal tunnel syndrome but may not work if the symptoms have already been present for several months. Symptoms may recur after successful conservative treatment. If symptoms do not improve after 2-3 months of conservative treatment, or if symptoms keep coming back later, surgery will be needed.

Nonsurgical Therapy

If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel syndrome. Methods may include:

  • Wrist Splinting:

    A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness. Nocturnal splinting may be a good option if you are pregnant and have carpal tunnel syndrome.

  • Corticosteroids:

    Your doctor may inject your carpal tunnel with a corticosteroid, such as cortisone, to relieve your pain. Corticosteroids decrease inflammation and swelling, which relieves pressure on the median nerve. Oral corticosteroids aren’t considered as effective as corticosteroid injections for treating carpal tunnel syndrome.

If carpal tunnel syndrome results from an inflammatory arthritis, such as rheumatoid arthritis, then treating the underlying condition may reduce symptoms of carpal tunnel syndrome, but this hasn’t been proved.

Surgery

If your symptoms are severe or persist after trying nonsurgical therapy, surgery may be the best option. The goal of carpal tunnel surgery is to relieve pressure on your median nerve by splitting the ligament pressing on the nerve. During the healing process after the surgery, the ligament tissues gradually grow back together while allowing more room for the nerve than existed before.

The surgery can be done as a mini-open procedure or via minimally invasive endoscopic surgery. Discuss this with your doctor before proceeding.

The fastest way to cure carpal tunnel syndrome and also the best long-term solution is to permanently decompress the nerve (carpal tunnel release). This involves cutting a thick band of tissue in the palm that is constricting the nerve. It is commonly done with a 3-5cm long incision in the palm which takes about 2 weeks to heal. Pain and weakness can last for 3-4 months, during which use of the hand is limited.


A much less invasive method offered at Hand Surgery Associates is endoscopic carpal tunnel release. This is done through a 7-10mm incision at the wrist, guided by a video camera. Because the cut is so small and not in the palm, the hand can be used for most light activities almost immediately after surgery. Only 1 or 2 dissolvable stitches are needed, and the wound heals within a week. Pain and weakness are less, and full hand function recovers in half the time. The scar is barely visible after a few months. Studies have shown that risks of complications are less with this method, when done by experienced surgeons.

In other cases, surgery involves making a larger incision in the palm of your hand over the carpal tunnel and cutting through the ligament to free the nerve.


More than 90% of people with carpal tunnel syndrome can be completely cured by surgery if treated within 6 months of noticing symptoms. Those who have had symptoms for several years may not be completely cured but do improve significantly, resulting in much better sleep and hand function.

Risks of surgery include injury to the nerve, causing worse pain and numbness, sensitive scar, and incomplete release of the nerve with no lasting improvement in the symptoms. All of these are rare when surgery is performed by experienced hand surgeons. Some people may experience prolonged recovery with pain and weakness of the hand lasting longer than 3 months. Symptoms may recur in up to 5% of people several years after surgery.

Post-Operative Care

After surgery, you are encouraged to gradually increase usage of your hands, working back to normal use, while avoiding forceful hand motions or extreme positions of your wrist. Soreness or weakness may take from several weeks to as long as a few months to resolve after surgery. If your symptoms were very severe before surgery, symptoms may take a few months to subside.

Following carpal tunnel release surgery, your hand will remain in a bandage for a couple of days, and you may need to wear a sling. You should keep your hand elevated for 48 hours to help reduce any swelling and stiffness in your fingers.

To help prevent stiffness, gently exercise your fingers, shoulder and elbow. You may be able to start these gentle exercises on the day of your operation.

How Can I Prevent Carpal Tunnel Syndrome?

Having good hand and wrist posture when working for long hours on a computer can decrease the risk of developing carpal tunnel syndrome. If performing repetitive work for long periods, taking a short break every hour to stretch and loosen the hand and wrist is recommended. Good control of diabetes and other conditions that predispose to nerve damage or compression is essential.