How is carpal tunnel syndrome treated?

Wearing wrist splints at night can help relieve night symptoms. Corticosteroid injections that decrease inflammation around the nerve can help your hand surgeon with the diagnosis or, in limited situations, can treat symptoms.

Surgical release of the carpal tunnel by cutting the ligament overlying the nerve and tendons in the palm of the hand enlarges the tunnel and decreases the pressure on the nerve. Soreness in the palm can last for weeks to a few months. Numbness and tingling can disappear quickly or slowly, but resolution of night symptoms usually occurs first. Strength in the hand and wrist can take a few months to return to normal. It is important to note that symptoms might not go away completely after surgery, especially in severe cases.

Carpal tunnel syndrome is typically either treated with a conservative or surgical approach. Conservative treatment includes wearing a splint to keep the wrist in a neutral position, hot and cold compresses, strengthening exercises for the wrist flexors and extensors, anti-inflammatories, and modifying activity or improving ergonomics.

A carpal tunnel release is used to surgically treat carpal tunnel syndrome. In this procedure, the surgeon will typically cut the ligament that is compressing the nerve. This releases the pressure and is successful most of the time, depending on how long the nerve has been compressed.

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Exercise: Stretching and strengthening exercises, under the direct supervision of a physical therapist, may help relieve symptoms.

Medications: Over-the-counter medications such as acetaminophen (Tylenol®) and nonsteroidal anti-inflammatory drugs (i.e. ibuprofen, aspirin) may help decrease pain. Additionally, corticosteroids (i.e. prednisone) may be injected into the wrist to reduce inflammation, relieve pressure, and provide temporary relief. Injectable corticosteroids are available only with a prescription. However, corticosteroids may not be beneficial for long-term treatment since symptoms may return. Additionally, corticosteroids may lower an individual's resistance to infections and increase blood sugar levels.

Splinting: At least 80% of patients with carpal tunnel syndrome report that wrist splints (hand braces) improve symptoms. Splints help to decrease pressure by keeping the wrist straight. Splints are available in most drug stores. Splints may be worn 24 hours a day or only at night. Wearing a splint at night may help reduce the pain. Additionally, splints may provide the most benefit if worn within three months of developing carpal tunnel symptoms.

Support groups: Support groups may help patients with carpal tunnel syndrome cope with their feelings about the condition.

Surgery: Surgery is usually recommended when symptoms last for six months. It involves cutting the band of tissue around the wrist to reduce pressure. Patients receive local anesthesia and may leave the hospital the same day of the surgery. Full recovery may take months. However, symptoms may be alleviated immediately following surgery. Surgery increases the risk of infection and may result in nerve damage, stiffness, and pain at the scar. It is important for patients to receive physical therapy after surgery to regain wrist strength.

Treating underlying diseases: Treating diseases that may be causing carpal tunnel syndrome, such as hypothyroidism (under active thyroid) or rheumatoid arthritis, may help alleviate symptoms.

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Carpal tunnel syndrome is a condition in which the median nerve is compressed as it travels through a narrow portion of the wrist. (This section is called the carpal tunnel.) Common symptoms include numbness and tingling in the fingers, as well as weakness of the thumb.

Many conditions can put a person at risk for developing carpal tunnel syndrome, including:

• Diabetes
• Pregnancy
• Thyroid disease
• Rheumatoid arthritis (or other causes of wrist arthritis)
• Injury to the wrist, such as fracture or repetitive trauma (as seen with jackhammer operators)
• Alcoholism

Treatment options include:

• Wrist splints. It may be helpful to rest the wrist in a position that provides maximal space for the median nerve. Wrist splints are often worn only at night. This helps prevent bending the wrist during sleep. This bending may worsen the symptoms.
• Anti-inflammatory medications. These drugs can reduce inflammation in the wrist and provide pain relief.
• Cortisone injections. This medicine can reduce inflammation and swelling in the carpal tunnel. However, the improvement does not tend to last long.
• Surgery. A minor operation can relieve symptoms of carpal tunnel syndrome by providing the median nerve with more space. This treatment is usually considered only after other treatments have failed.

Reversing or treating any contributing conditions can also be helpful. For example, treating rheumatoid arthritis may prevent the worsening of symptoms or reduce existing symptoms. So can tightly controlling diabetes. And an ergonomic evaluation of your workspace may help. For example, your chair and desk can be positioned so you can avoid excessive wrist flexing or extension.

If symptoms of carpal tunnel syndrome are not well controlled, nerve injury may become permanent. So, see your doctor about your condition and review all of these treatment options.

The goal of treatment for carpal tunnel syndrome is to allow you to return to your normal function and activities and to prevent nerve damage and loss of muscle strength in your fingers and hand.

Treatment options include: 

• Home treatment, such as changing or avoiding activities that may be causing symptoms and wearing a wrist splint. 

• Physical therapy. This includes ultrasound, stretching and range-of-motion exercises. In some clinics, these therapies may be done by an occupational therapist.

• Medicines, such as nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and reduce inflammation. In some cases, oral corticosteroids or corticosteroid injections into the carpal tunnel may be considered. 

• Surgery. Surgery is sometimes recommended when other treatment hasn't helped, if you've had carpal tunnel syndrome for a long time or if there is nerve damage or the risk of nerve damage. 

Carpal Tunnel Syndrome: Should I Have Surgery? What to think about

Treatment for carpal tunnel syndrome is based on the seriousness of the condition, whether there is any nerve damage and whether other treatment has helped. If your symptoms are mild, 1 to 2 weeks of home treatment are likely to relieve your symptoms.

Other treatments for carpal tunnel syndrome include:

• Physical therapy. This includes ultrasound, stretching and range-of-motion exercises. In some clinics, these therapies may be done by an occupational therapist.

• Wrist splints. 

• Retraining (learning new ways of doing things), and ergonomic considerations (such as having your body in the correct posture and position and using equipment that is right for your strength and ability). 

Wrist Care: Preventing Carpal Tunnel Syndrome Complementary and alternative treatments

Some people try complementary and alternative treatments to help with the symptoms of tingling, numbness, weakness or pain felt in the fingers or hand. There is not strong evidence that they help. 1 Some of these treatments include

• Acupuncture. 

• Yoga.

• Manual therapies, such as mobilization. 

Vitamin B6 (pyridoxine). High doses of vitamin B6 can cause nerve problems (neuropathy). Talk to your doctor before you use vitamin B6 supplements.