Carpal Tunnel Syndrome Treatment
Carpal Tunnel Syndrome is a relatively common and new medical condition. It wasn’t until the end of World War II that it was fully described. Yet, many people connect the syndrome with using keyboards too much or doing the same repetitive tasks and wrist movements.
While the entire nervous system is complex, the nerve that can indirectly cause CTS is the median one. It starts in the neck and goes all the way to the wrist traveling on the inner side of the arm. Furthermore, this is one of the five primary nerves originating in the brachial plexus.
Not only is it the only nerve going directly through the carpal tunnel, but it is also the nerve that controls sensation and feeling in fingers. However, only four fingers are controlled by this nerve, and the pinky is the only one that isn’t.
The tunnel we referred to is around an inch wide, and there are nine tendons going through (besides the median nerve). Finally, the problem occurs when that nerve gets compressed due to pressure from either outside or inside of the tunnel.
When there is pressure on the median nerve, the person will feel numbness in fingers. Furthermore, the sensation can also manifest as mild electric shock or pain in the carpal area.
If untreated, CTS can only get worse. The pain can progress from the wrist to the forearm and eventually to the entire arm and then neck.
During the early stages, the person may feel pain, numbness, and tingling originating in those four fingers. Interestingly, the unpleasant sensation will occur only on the thumb side of the ring finger. Other three fingers will be completely affected.
In addition, if the condition remains untreated, the pain can transfer from the hand and the wrist to the rest of the arm. Usually, symptoms of carpal tunnel will be increased clumsiness and weakness in hands. CTS doesn’t have to occur on both wrists, but it is possible.
Finally, the muscle located in the base of the thumb can atrophy over time due to CTS.
When it comes to treatment, there are several options that patients can take. Naturally, they will depend on the severeness of the syndrome and the current stage. There are several ways to confirm CTS. The doctors will usually perform several tests to both confirm CTS and eliminate other potential conditions. The most common methods are x-ray, physical exam, electromyogram, and nerve conduction study.
When it comes to treatment, we can distinguish two categories. The first one is nonsurgical and the second one is some kind of surgery.
- Wrist splint. One of the first things a patient would get as a treatment for CTS is a wrist splint and especially in early stages. In the beginning, pain and symptoms will appear mostly during the night. Immobilization of the wrist is a good idea, and usually, doctors would recommend wearing the splint during the night only. This way, there will be no room for the wrist to move and cause additional pain during sleep. Nighttime wrist splitting is a good idea, especially if the patient is pregnant. One of the best things about wrist splinting is that there are no potential side-effects. While it is suggested that splints should be used only during the night, it is recommended to use them for any wrist straining activity during the day.
- NSAIDs. One of the options the doctor can choose is using nonsteroidal anti-inflammatory drugs. While there is no evidence that these NSAIDs will help with CTS, they will surely help alleviate the pain fast. Drugs like ibuprofen (Advil, Motrin) should be used.
- Corticosteroids. Sometimes using steroids is the best course of action. Corticosteroids like cortisone might reduce swelling in the carpal tunnel. The doctor will inject cortisone directly into the carpal tunnel to help relieve the pain. While the patient can opt to use oral corticosteroids, they are not as effective as injections. These steroid-based drugs will help with both swelling and inflammation. Depending on the stage of the syndrome, further actions might be needed since steroid-based medications are only a temporary solution.
- Physical therapy. There are different types of physical therapy that might help ease the symptoms of CTS. Physical therapy may be used after surgery or in the early stages of CTS. The therapy consists of exercises for both the wrist and the hand. The main problem with physiotherapy is that it tries to reverse years and years of pathology that is inside the carpal tunnel. However, there are those who claim that it is possible to reduce pain and stress through this form of therapy.
Naturally, if the condition is severe enough, the surgery might be the only option available. Furthermore, if the condition doesn’t respond to any other treatment, the patient would be suggested to undergo an operation.
The general idea behind these surgeries is to relieve the pressure on the pinched nerve by cutting the ligament that is pressuring the median nerve. This way, there will be additional room for the nerve, and the symptoms should go away if the nerve damage isn’t too severe.
The surgery can be done with or without anesthesia. When anesthesia is used, it can be local, regional, or sometimes general. While symptoms of CTS can be bearable for years, if constant pain is present, and no other method can help anymore, the surgery is the best course of action (especially if the thumb muscle atrophies).
There are two techniques surgeons could use to perform the carpal tunnel release.
- Endoscopic surgery. Endoscopy is a way of looking inside the body. The surgeon would use a device with a camera attached on it to see inside the tunnel. Furthermore, after “locating” the issue, the surgeon would cut the ligament through one (or two) small incisions on the hand or, sometimes, wrist. The positive side of the endoscopic surgery is that the patients may feel less pain in the few weeks after the surgery (compared to the open surgery).
- Open surgery. The surgeon would make an incision on the palm side of the patient’s hand above the carpal tunnel and proceed to cut through the ligament to release the pinched nerve.
While it is still uncertain what causes the tissue to swell and what causes the pressure on the nerve, there are several factors that can contribute to CTS. Obesity, repetitive wrist movement, genetics, pregnancy, and rheumatoid arthritis are all considered risk factors.
However, there are several things that you could do to lower the chances of developing CTS.
- Avoid constant repetitive wrist movement
- Stop with the activities that cause you any form of wrist/hand pain
- Take breaks when doing something that includes strain on the wrists or physical activity
- Try keeping your wrists in the neutral position as much as possible. Avoid doing anything in wrists’ limits (both flexing and extending)
- Use the largest joints when lifting (shoulders) to avoid additional stress on the wrists
- Avoid using power tools that vibrate when working
- Avoid sleeping on your wrists
While CTS is still heavily determined by the person’s genetics, there are still ways to lower the risk of suffering from this syndrome. Naturally, not all of them will be 100% effective, and even if you do all the things mentioned, it is not certain that you will avoid the syndrome.
Today, there are around 5% of people in the United States that have carpal tunnel syndrome. Furthermore, the condition is more likely to occur in women (around 33% more likely).
Finally, if you feel any form of pain or unpleasantness in your wrists/hands/fingers, it might be the best idea to consult your doctor to ensure that everything is well. If not, treatment for the earliest stage is much less painful and difficult. So try to take care of your health and avoid having a preventable surgery.