Conventional Treatments for Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a common medical condition that affects the hand(s) and wrist(s). The carpal tunnel passage is a narrow canal/tube located in each wrist. It holds the median nerve and tendons that connect the hand and forearm. The median nerve controls movement and sensation in the thumb and the fingers except the pinky and half of the ring finger.

Carpal tunnel syndrome occurs when the carpal tunnel is compressed or becomes too narrow, which creates pressure on the median nerve. The resulting inflammation can cause loss of sensation in the fingers and hand.

Conventional medical treatments for carpal tunnel syndrome include medications, physical and occupational therapy, or surgery. Treatment should begin as soon as possible to obtain the best results.

Medications

Over-the-counter or prescription medications, such as nonsteroidal anti-inflammatory drugs, corticosteroids, and anesthetics, can help manage pain and other symptoms of carpal tunnel syndrome.

• Nonsteroidal anti-inflammatory drugs (NSAIDs) help decrease inflammation and pain. NSAIDs include oral medications, such as ibuprofen or aspirin, or topical treatments, such as diclofenac gel.
• Corticosteroids, such as prednisone, may be prescribed to reduce inflammation, which relieves pressure on the median nerve. Corticosteroids can be taken orally or injected into the wrist by a health care provider.
• Anesthetics, such as lidocaine, can be used to relieve pain. Methods of administration include topical application or local injection.

Therapies

Both physical therapy and occupational therapy can help manage symptoms of carpal tunnel syndrome. Benefits of physical and occupational therapy for carpal tunnel syndrome include the following: 

• Improved strength and movement of the hand and fingers
• Increased flexibility and reduced pain in the hand and wrist
• Improved mobility and performance of everyday tasks 

Surgery

Carpal tunnel release surgery is a common outpatient procedure used to treat moderate to severe carpal tunnel syndrome. Local or regional anesthesia (with light sedation) is used during the procedure. Carpal tunnel surgery involves cutting the ligament that sits atop the carpal tunnel; this relieves pressure on the median nerve. Recovery can take months, and residual weakness is common. The two different methods of carpal tunnel release surgery include open release surgery and endoscopic surgery.

• Open release surgery is the most common surgical procedure for carpal tunnel syndrome. During open release surgery, a surgeon makes an incision of approximately 2 inches (5.08 centimeters) in the wrist and cuts the carpal ligament. This enlarges the carpal tunnel.
• Endoscopic surgery typically involves a faster recovery and less discomfort compared to traditional surgery; however, it may also involve an increased risk of complications and need for further surgery. During endoscopic surgery, a surgeon makes one or two half-inch incisions in the wrist and palm and inserts a camera attached to a tube through the opening. The carpal ligament is cut with a small knife that is inserted through the tube.