Carpal Tunnel Syndrome.
Last updated Thursday, February 10, 2005
Management and treatmentTreatment Mild cases of carpal tunnel syndrome may be treated with braces,
medicines, injections, or self-management techniques. Moderate and
severe cases of CTS are sometimes treated with surgery.
Streaming video
 Dr. Trumble discusses hand injuries and surgery in the UWTV video, "Carpal Tunnel Syndrome: Advances in Treatment".
Self-management Adjusting your daily work activities may help prevent and/or relieve CTS symptoms. Here are some ways you can do this:
- Rest your wrists and hands from time to time
- Alternate tasks to reduce the pressure on your wrist
- Delegate tasks that bother your hands to co-workers or family members
- Modify or change any daily activities, including hobbies, that put too much pressure on your wrist.
If you think your CTS may be due to activities at your job,
talk to your doctor and your manager. They may be able to help you make
some changes that will relieve the problem. This could include
adjusting your work area or reducing the amount of time you spend at
particular tasks. An occupation therapist can help you find ways to
modify your activities or suggest tool modifications to put less stress
on your wrists. Diet CTS related to a vitamin deficiency can be treated with Vitamin B6,
though most patients with a normal diet do not have significant vitamin
deficiencies.Medications Oral anti-inflammatory medicines such as aspirin or ibuprofen can reduce inflammation, swelling, and pain.Surgery For moderate and severe cases of CTS, surgery is generally
recommended. Although braces or medications may help, they will not
relieve all the symptoms of pain, numbness or tingling. Without surgery
to relieve pressure on the nerve, these symptoms may become permanent.
The procedure, called carpal tunnel release, releases the transverse
carpal ligament to relieve the pressure on the median nerve.
This can be done through:
- an incision from the palm to the wrist,
- a limited incision in the palm only, or
- an endoscopic carpal tunnel release using a special fibro-optic instrument.
The last two options decrease the length of the scar, which can speed recovery.
This is usually a simple operation that can be done on an outpatient basis.
After surgery, you will probably have some use of your hand within
two weeks or so, but you should avoid activities that put too much
stress on your wrist.. Usually, you will regain full use of your hand
about six to 10 weeks after surgery. (Recovery time may be three to
four months for those people who do a lot of manual labor.) Your
restrictions after surgery will depend on whether or not you had
surgery on your writing hand. Limitations may include:
- Driving: Most people can drive one to two days after surgery.
- Writing: Although you can do some writing one week after surgery, it will often take 4-6 weeks to write comfortably.
- Gripping and pulling: Light activities may be possible within 6-8
weeks, but full grip strength does not return for 10-12 weeks. Our
surveys have shown that grip strength continues to improve for up to
one year.
Possible side effects and complications of the surgery include:
- Pain and soreness at the surgical site can be quite common.
- Symptoms can return even when precautions are taken to avoid excess vibration or flexion after surgery.
- Although nerve injury during surgery is extremely rare, it can
occur, especially if the nerve follows an unusual path across the wrist.
Results from surgery are generally quite good if severe weakness has not developed. Joint aspiration Injections of corticosteroids,
or cortisone-like medications, into the wrist can may reduce the
swelling that causes pressure on the median nerve. These injections
often bring significant relief for many people with CTS.Splints or braces A wrist splint or brace (see figure 3) may be used to keep the wrist
in a straight position while you sleep. The brace prevents extreme
wrist motion. You may be requested to wear a daytime splint if the
symptoms persist during your daily activities. The splint helps reduce
swelling that may be causing CTS.
An occupational therapist can make a splint that will meet your
needs. A wrist brace may be prescribed for symptoms of a few weeks or
months.
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