Carpal tunnel syndrome is a condition in which pressure is exerted upon the median nerve at the point where it crosses the wrist through a passage created by a thick band of tissue, called the transverse carpal ligament, and bony structures of the carpal bones. Causes are many, ranging from work-induced, to trauma and pregnancy.
Treatment options vary depending upon the severity of the symptoms, and whether there is any sign of nerve damage, as determined by testing such as physical examination or electro-diagnostic testing, where a weak electrical signal is introduced near the median nerve in the neck or upper arm, and the speed at which it arrives at an end point in the thumb or specific fingers is measured.
Night Splints
Night splints are, in actuality, types of wrist braces that, when applied to the hands and wrists, maintain the hand in a slightly "dorsi-flexed" (extended upward toward the back of the hand) position. This position allows for a reduction of any pressure that is being applied to the median nerve and can help relieve symptoms such as numbness and tingling of the thumb, index and long fingers.
These splints can be as simple as fabricated plaster strips with an ace bandage, or as fancy as lace-up braces with metallic inserts for upward hand positioning, obtained by prescription or purchased at a pharmacy.
Short-Term Steroid Therapy
Occasionally, treatment for carpal tunnel syndrome can come in the form of a short burst of oral steroids, used in an effort to reduce inflammation and swelling that can be placing undue pressure on the median nerve as it courses through the wrist.
The most common name for this medication is called the "steroid dose-pack", or "Medrol dose pack".
This treatment typically consists of a five-day regimen of oral steroids (similar to the substances produced by your adrenal glands but more concentrated). The first day of treatment consists of taking the largest dose of the steroid, and methodically reducing the dosage daily for the remainder of the 5-day regimen.
Steroid Injection
Occasionally, it becomes necessary to undergo a local injection of steroid ( i.e. "cortisone") into the carpal tunnel itself. This introduction of steroid coats and soothes the angry, inflamed and swollen nerve, as well as the surrounding tendons and soft tissues.
The anti-inflammatory actions of the steroid, combined with the direct injection of it in the area it is most needed, can serve as a very beneficial treatment option, especially if the condition is chronic and moderate-to-severe.
Surgical release
In cases of severe symptoms of numbness, local muscle wasting and progressive signs of impending nerve damage, surgical release may be the most appropriate treatment option.
This is accomplished by the performance of one of a variety of procedures designed to surgically release the transverse carpal ligament, thereby relieving unwanted pressure on the median nerve and surrounding tendons. The procedure can be performed endoscopically or through "mini incisions" to lessen pain and shorten recovery. This treatment option is the most direct and has the best record of outcomes in moderate to severe carpal tunnel syndrome.
