Carpal Tunnel Syndrome Treatments

Do you feel numbness or a tingling sensation in your hand at night? Do you sometimes experience pain in your wrist and hand, particularly at night? Do you have difficulty holding objects without dropping them? If you have answered “yes” to any of these questions, you might be experiencing symptoms of carpal tunnel syndrome.
 

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is a common problem that affects the use of your hand. It most often occurs when the median nerve in the wrist becomes inflamed after being aggravated by repetitive movements such as typing on a computer keyboard or playing the piano. The condition may cause progressive narrowing or compression (squeezing) of the median nerve.
 
The “carpal tunnel” is formed by the bones, tendons, and ligaments that surround the median nerve. Since the median nerve supplies sensation to the thumb, index, and middle finger, and part of the ring finger, and provides motion to the muscles of the thumb and hand, patients will often notice numbness and weakness in these areas. Finger numbness or wrist pain may be most significant during the night, when it can actually awaken a patient from sleep. During the day, it may occur during any activities that involve bending of the wrist.
 
Symptoms can include hand and wrist pain, a burning sensation in the middle and index fingers, thumb and finger numbness, or an electric-like shock through the wrist and hand. These symptoms are often exaggerated when the wrist is bent forward.
 

Common Causes of Carpal Tunnel Syndrome

Diseases or conditions that may predispose the development of carpal tunnel syndrome include pregnancy, diabetes, menopause, broken or dislocated bones in the wrist, and obesity. Additional causes include repetitive and forceful grasping with the hands, bending of the wrist, and arthritis.
 
Any repetitive motions that cause significant swelling, thickening, or irritation of membranes around the tendons in the carpal tunnel can result in pressure on the median nerve, disrupting transmission of sensations from the hand up to the arm and to the central nervous system.
 

Diagnosing Carpal Tunnel Syndrome

It is important to seek medical assistance when you first notice persistent symptoms. Do not wait for the pain to become intolerable.
 
Before your doctor can recommend a course of treatment, he or she will perform a thorough evaluation of your condition, including a medical history, physical examination, and diagnostic tests. Your doctor will document your symptoms and ask about the extent to which these symptoms affect your daily living. The physical examination will include an assessment of sensation, strength, and reflexes in your hand.
 
If conservative treatment such as medication or physical therapy does not provide sufficient relief, your doctor may perform diagnostic studies to determine if surgery is an effective option. These diagnostic studies may include:
 
  • X-ray: An x-ray will show the bones of the wrist and determine if any abnormalities may be contributing to carpal tunnel syndrome or another disorder.
  • Electromyogram and Nerve Conduction Studies (EMG/NCS): These tests primarily study how the nerves and muscles are working together. They measure the electrical impulse along nerve roots, peripheral nerves, and muscle tissue.
 

Conservative (Nonsurgical) Treatment Options

The main objective of conservative treatment is to reduce or eliminate repetitive injury to the median nerve. In some cases, carpal tunnel syndrome can be treated by immobilizing the wrist in a splint to minimize or stop pressure on the nerves. If that does not work, patients are sometimes prescribed anti-inflammatory medications or cortisone injections in the wrist to reduce swelling. Also, hand and wrist exercises may be recommended both during and after work hours. Treatment for carpal tunnel syndrome may include rest, the use of a wrist splint during sleep, or physical therapy. Conservative treatment methods may continue for up to six or eight weeks.
 

When Surgery is Necessary

If patients experience severe pain that cannot be relieved through rest, rehabilitation, or nonsurgical treatment, there are several surgical procedures that can be performed to relieve pressure on the median nerve. Neurosurgeons are uniquely qualified to perform these operations, as they are trained to treat disorders affecting the entire nervous system. The most common procedure is called a carpal tunnel release, which can be performed using an open incision or with endoscopic techniques.
 
The open incision procedure, or carpal tunnel release, involves the doctor opening the wrist and cutting the ligament at the bottom of the wrist to relieve pressure. The endoscopic carpal tunnel release procedure involves making a smaller incision and using a miniaturized camera to assist the neurosurgeon in viewing the carpal tunnel. The possibility of nerve injury is slightly higher with the endoscopic surgery, but the patient’s recovery and return to work timeframe is quicker. It is important to discuss in detail these two types of surgery with the particular surgeon you have chosen to perform your surgery.
 
However, only a low percentage of patients require surgery. Factors leading to surgery include the presence of persistent neurological symptoms and lack of response to conservative treatment. Recurrence of symptoms after surgery for carpal tunnel syndrome is rare, occurring in less than 5% of patients.
 
Content Source: American Association of Neurological Surgeons