1. Prevention
Strive for good posture and correct wrist position and seek a more ergonomic workplace environment. Use tools and handles to maintain low-stress, natural positions and movements during work. Stretch regularly and take frequent breaks to avoid repetitive stress to the wrist. Wear splints to keep the wrists straight. Adjust chair heights and computer keyboards and rotate tasks and job functions with others workers from time to time, if necessary. A cold environment can prompt hand pain and stiffness, so wear fingerless gloves to keep your hands warm and flexible.
2. Non-surgical treatments
Underlying causes, such as diabetes or arthritis, should be treated first. Basic initial treatment involves resting the affected hand and wrist for at least two weeks, avoiding aggravating activities, changing patterns of hand use and wearing a splint to avoid further damage from twisting or bending. Applying ice packs and taking drugs such as ibuprofen can help reduce inflammation. Taking vitamin B6 (pyridoxine) supplements have been reported to relieve some symptoms, although studies are inconclusive. Corticosteroid injections into the carpal tunnel may provide temporary relief of symptoms. Acupuncture, yoga and stretching and strengthening exercises recommended by a physical or occupational therapist may help relieve pain as well. A wrist brace or splint can help relieve night pain by preventing wrist flexion that naturally occurs when we sleep.
3. Surgical treatments
Surgery should be considered if other treatments are ineffective or in cases of muscle atrophy and weakness. Carpal tunnel release is one of the most common surgical procedures in the United States. It involves making an incision in the palm and cutting the roof of the carpal tunnel. Releasing the transverse carpal ligament (TCL) increases the size of the tunnel and reduces the pressure on the median nerve. Another technique uses one or two endoscopes (small cameras attached to a tube) to visualize and cut the carpal ligament. Endoscopic surgery may allow for faster recovery, less scarring and an earlier return to work, but can be more difficult to perform.
4. Expectations of surgery
You may feel soreness, swelling and stiffness in the palm immediately after surgery. Occupational or hand therapy after surgery can help regain motion and restore wrist strength. Complications are rare, but may include bleeding, infection and nerve injury from the surgery itself. The majority of patients can expect to recover completely, albeit gradually (often over one year). As a general rule, the longer the symptoms of CTS, the longer it takes to improve. Usually, the night pain improves first, then the general numbness. Muscle atrophy is the last to recover, but sometimes incompletely, depending on how long the nerve was compressed.
5. I had a carpal tunnel release, but I still have pain!
The most common cause of recurrent symptoms is an incomplete TCL release. Sometimes, even after completely releasing the TCL, other conditions may affect the nerves, which can give you continued symptoms. The most common is diabetic peripheral neuropathy, which can cause numbness in the fingers and toes. Furthermore, the nerve can be injured at a completely different location. The fibers of the median nerve start all the way back in the neck, and can be compressed anywhere from there to the wrist.
