Carpal Tunnel Syndrome Treatments

Carpal Tunnel Syndrome has become a problem faced by many today, as our daily lives often include hours of typing and repetitive motion causing strain on our hands and wrists. Carpal Tunnel is often characterized by a numbness and tingling sensation in your hand but can also have varying degrees of pain along with these other symptoms. 

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is a common problem that affects the use of your hand, and occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist. The median nerve controls sensations and muscle movement to the palm side of the thumb and fingers. The carpal tunnel itself is a narrow, cluster of ligament and bones at the base of the hand and houses this median nerve.  
What happens with carpal tunnel syndrome is the tendons in this area become thicker from overuse and irritation, this leads to increased swelling which narrows the tunnel and causes the median nerve to be compressed. Although painful sensations may indicate other conditions, carpal tunnel syndrome is the most common and widely known of the entrapment neuropathies in which the body's peripheral nerves are compressed or traumatized.
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.

Common Causes of Carpal Tunnel Syndrome

Carpal Tunnel Syndrome usually occurs due to a combination of factors, stemming from a repetitive use and strain on the wrist ligaments. However, other diseases and conditions may predispose the development of carpal tunnel syndrome; these include heredity, pregnancy, diabetes, menopause, broken or dislocated bones, in the wrist, and obesity. 
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 that you believe may be carpal tunnel syndrome. 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. During the diagnosis, your doctor will document your symptoms and ask about the extent to which these carpal tunnel symptoms affect your daily living. Your doctor will also perform a physical examination which 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.

Nonsurgical Treatment Options for Carpal Tunnel Syndrome

The main objective of all nonsurgical 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.
Stretches, Exercises and Tests for Carpal Tunnel Syndrome
While we do recommend getting diagnosed by a licensed professional, there are at home tests patients can do to see if they may have carpal tunnel syndrome. The Tinel’s test is performed by lightly tapping the inside of the wrist over the median nerve, if numbness, tingling or a “pins and needles” sensation occurs in the hand it is advised to come in for further diagnosis. Another carpal tunnel syndrome test is the Phalen’s sign test, in which the arms are extended, wrists flexed and let to hang out and down for 60 seconds, if numbness, tingling or pain occurs you may have carpal tunnel. While these tests are not always 100% accurate they will provide a good indicator to come in and talk to a specialist.
Aside from our nonsurgical treatments, there are stretches, exercises and at home practices patients can try to alleviate carpal tunnel pain. Stretching exercises include: the prayer stretch, in which a patient places both hands together as if to pray and gently pushes together and down to stretch wrist muscles, and the wrist flexor and extensor stretches, which involve is lightly bending back an outstretched, palm up or palm down hand with the opposite hand.  Other stretches include: wrist and arm circles, arm curls, thumb stretches and five-finger stretches.

When Surgery is Necessary

While only a low percentage of patients require surgery, if nonsurgical treatments are not effective it may be necessary, factors leading to surgery include the presence of persistent neurological symptoms and lack of response to conservative treatment.
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.
It is important to note that recurrence of symptoms after surgery for carpal tunnel syndrome is rare, occurring in less than 5% of patients.