Carpal Tunnel Syndrome Treatment

What Is Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) is a repetitive motion condition affecting one or both hands and wrists. The pain, numbness, and tingling patients experience in their fingers and wrists happens due to compression of the median nerve. This nerve travels through a narrow canal which is called the carpal tunnel. The carpal tunnel passageway in the wrist surrounds tendons that control finger movements and the median nerve, which provides sensation to each finger except the little finger (“pinky”). The dorsal (bottom) side of the carpal tunnel consists of the wrist bones, and the palmar (top) side of the tunnel has the transverse carpal ligament.

The median nerve runs from your elbow through the wrist, and when the carpal tunnel narrows, it compresses it. This added pressure dulls sensation in the thumb, index and middle fingers, as well as half of the ring finger. Some of the strength at the base of the thumb is also lost over time.

CTS can be successfully treated and symptoms alleviated either through nonsurgical or surgical treatments.

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Symptoms of Carpal Tunnel Syndrome

Symptoms vary from one person to the next, but in general, include:

  • Numb, burning, tingling, or itching fingers and hands
  • Chronic pain, which usually gets worse at nighttime
  • Weak grip

What Causes Carpal Tunnel Syndrome?

The cause of CTS is not fully understood, but there are risk factors associated with the development of this condition. Overuse is the most common reason a person develops CTS.

Risk factors for CTS may include:

  • Family history: Smaller carpal tunnels are a hereditary trait
  • Wrist fracture or dislocation
  • Obesity
  • Repetitive wrist work
  • Pregnancy
  • Rheumatoid arthritis
  • Congestive heart failure
  • Tumors or growths in the carpal tunnel
  • Alcoholism
  • Age

Diagnosis of Carpal Tunnel Syndrome

Your doctor will take your medical history and ask about any symptoms that relate to CTS. One of the first tests your doctor will perform is “Tinel’s sign,” which involves using a tiny hammer to tap over the palmar side of the wrist to check if it produces a tingling sensation. X-rays may be ordered if you have limited wrist motion or if there is evidence of arthritis. It can also rule out any other condition mimicking CTS. Nerve conduction studies are also useful in determining how well your median nerve is working.

Treatment for Carpal Tunnel Syndrome

While not all patients can be cured of their CTS, treatments to combat the condition are highly effective for the vast majority of patients. Treatments will depend on the severity of symptoms and any associated disabilities that result from CTS. Your doctor may recommend conservative treatments to start, and if those prove ineffective, surgery is the next step. Treatment should begin as soon as possible after symptoms start.

Nonsurgical Treatments of CTS

Some of the conservative treatments for CTS include over-the-counter pain relievers, rest, ice, hand braces to immobilize the wrist, ultrasonic therapy, hand/wrist splinting, oral steroids, and corticosteroid injections. Workplace modifications are also recommended, such as the use of an ergonomic keyboard and mouse, for those whose jobs involve daily computer usage.

You should minimize stress on the hands and wrists by relaxing your grip, taking frequent breaks and alternating tasks, avoiding bending the wrist all the way up or down, and keeping your hands warm.

Surgical Treatment of CTS

For those with moderate to severe CTS, carpal tunnel release surgery may be the best option to increase the size of the carpal tunnel. Surgery may be the first line of treatment if CTS symptoms are already severe, but it is usually taken after nonsurgical treatments have produced little or no improvement. Surgery can either be performed in an “open” procedure, or through a newer procedure called endoscopic surgery, but either surgery is performed on an outpatient basis. In both types of surgery, the goal is to divide the transverse carpal ligament to reduce pressure on the median nerve in order to provide relief, so the patient can regain sensation and strength in the fingers, hands, and wrists.

  • Open surgery: This type of surgery is the traditional method. To access the carpal tunnel, your surgeon will make a one to three-inch incision on the palmar side of the wrist to directly see the structures inside. Instruments are used to divide the skin and the transverse carpal ligament.
  • Endoscopic surgery: This is a newer, more technologically-advanced type of surgery, which has been performed more frequently since it was introduced in the 1990s. The incision(s) and resulting scar are much smaller in this type of surgery. A tiny camera is used so the surgeon can see the structures inside the carpal tunnel and, like in open surgery, the transverse ligament is cut.

Once surgery is complete, your hand(s) and wrist(s) will be wrapped and put into a splint to prevent any movement during recovery.

After surgery, physical therapy is often necessary to complete the healing process, as well as a period of rest for the hands and wrists. Heavier activities should be limited for at least 4 to 6 weeks. Wrist stitches are removed 10 to 14 days after surgery, and then hand and wrist physical therapy is prescribed.

Recovery after surgery may take time, especially if your CTS was severe or if the nerve was compressed for a long period of time. Most patients who undergo CTS surgery achieve complete relief of their symptoms; however, a minority will have continued symptoms. Rarely, CTS can reoccur.

Risks of Surgery

Any surgery comes with some risk, especially if general anesthesia is used. Some of the risks include incomplete ligament release, wound infections, unfavorable scar formation, and nerve injuries.

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