Carpal tunnel syndrome is a painful condition involving compression of the median nerve by adjacent tissues inside the wrist. Treatments that decompress the nerve can provide lasting relief. According to the National Institutes of Health, nonsurgical techniques are most effective below age 50, with mild to moderate, non-constant symptoms that have been occurring for less than 10 months. Surgery is reserved for the most severe symptoms.
Rest and Splinting
Start resting as soon as symptoms begin. Completely resting the hand and wrist for at least two weeks is most effective, although impractical for most working individuals. If you must use you hands, avoid nonessential hand-straining activities, such as golf or sewing. Immobilize your wrist in a splint to avoid further damage. Use cold packs to reduce inflammation and a heating pad when other symptoms occur.
Splints can be hard-shell or soft. Always use them during sleep. Limit use during the day to avoid unconsciously stressing your hand. The more your wrist is bent, the more pressure on the median nerve--and more pain. Keep your wrist in the neutral position, level with the forearm, as often as possible.
Manipulative Therapy
Exercises help to stretch and loosen the tissues running through the carpal tunnel. You can easily perform exercises such as wrist range-of-motion movements, active and passive finger spreading, and finger curling.
Massage will drain fluid from inside the carpal tunnel and also allow tissues to move more freely inside the carpal tunnel. Physical therapy consists of various techniques to both loosen and strengthen tissues to relieve pressure inside the carpal tunnel. Different kinds of physical therapy yield different success rates, although those professionally applied are most effective and provide lasting results.
Other Nonsurgical Therapy
Active medical devices are designed to alter the anatomy of the carpal tunnel and soft tissues within. They do so by actively manipulating the skin and other tissues over the wrist. This changes the shape of the carpal tunnel to provide pressure relief on the median nerve.
Yoga and acupuncture are considered alternate therapies, yet can be highly effective in relieving symptoms. Their popularity is growing because their results are lasting, and in the case of yoga, can be easily incorporated into a daily routine that provides additional health benefits.
Drug Therapy
Oral medicines, particularly nonsteroidal anti-inflammatory drugs like ibuprofen, are the most common treatments of carpal tunnel syndrome. They reduce swelling inside the carpal tunnel and also relieve pain. They provide temporary pain relief, however.
Some steroids like prednisone can be injected directly into the wrist. This reduces swelling and relieves pressure on the median nerve to provide immediate, temporary relief.
Surgery
Surgery involves severing the carpal ligament around the wrist to reduce pressure on the median nerve. Recovery times and functional outcomes vary greatly.
Open release surgery is the traditional procedure. It consists of making an incision up to 2 inches in the wrist to cut the ligament. This requires the most recovery time.
Endoscopic release surgery is far less traumatic and allows for faster functional recovery and less postoperative discomfort. Either one or two small incisions, called portals, are made in the wrist and palm. The doctor inserts a camera and surgical instruments to cut the ligament.
