The initial carpal tunnel syndrome treatment steps include some medications and splints.
- Anti-Inflammatory Medications
Anti-inflammatory medications or NSAIDs (e.g. Motrin or Advil) can decrease inflammation in the carpal tunnel and can also decrease carpal tunnel syndrome symptoms.
- Wrist Brace
The brace helps to stabilize the carpal tunnel in its neutral position. The carpal tunnel is at its widest diameter in this position and the nerve is least compressed. Wearing the splint at night is especially important, as well as during activities that tend to irritate your carpal tunnel syndrome.
The next step in carpal tunnel syndrome treatment can be a cortisone injection to the area to decrease inflammation around the nerve. The cortisone injection is often effective because the medication is delivered to the source of the problem; however, steroids shoulder be injected sparingly, and if the carpal tunnel syndrome returns, surgery may be considered.
Injections of cortisone into the carpal tunnel work about 80% of the time. However, this relief is often temporary, and the symptoms may return. Recent research has shown that the carpal tunnel injection is probably an effective treatment for at least one year in many patients. The injection can also be very helpful in situations where the diagnosis of carpal tunnel syndrome is unclear.
If these treatments do not work, do I need surgery?
Surgical treatments are available and effective in the treatment of carpal tunnel syndrome. The most common procedure is the carpal tunnel release. A carpal tunnel release involves making an incision in the fibrous sheath around the carpal tunnel. By releasing tension in the carpal tunnel, the pressure is removed from the nerve.
If a carpal tunnel release is done, it is most commonly performed by a "open" technique. To perform an open carpal tunnel release, your surgeon makes a 4 centimeter incision down the middle of the palm. Your surgeon carefully dissects the tissues down to the carpal tunnel. The carpal tunnel is opened up to relieve the pressure on the nerve. The surgery only takes about 15 minutes, and can be performed under local, regional, or general anesthesia.
What is an endoscopic carpal tunnel release?
A carpal tunnel release can now be done through a small incision and a camera called an endoscope. In this procedure, a small (about 1 centimeter) incision is made by the wrist. Through this incision, a small camera is inserted into the carpal tunnel. A small knife attached to the camera is then used to release the carpal tunnel.
Both procedures are effective in the treatment of carpal tunnel syndrome. Many surgeons prefer the open carpal tunnel release because it is easy to ensure there is adequate relief of tension around the nerve. Furthermore, the incision from an open carpal tunnel release tends to heal well with few problems. Some surgeons have also reported complications of the endoscopic carpal tunnel release due to inadvertent cutting of a nerve.
What are the complications of a carpal tunnel release?
The most common complications of surgical release of the carpal tunnel are injury to the nerve and incision pain. Injury to the nerve usually results in a permanent area of numbness around the base of the thumb; this occurs in about 5-8% of surgeries. Prolonged pain at the site of the incision is uncommon, but can occur in about 1-2% of cases.