Carpal Tunnel Syndrome Treatment

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome is the most common nerve constriction causing hand numbness. It occurs when excessive pressure is placed on the median nerve as it travels across the wrist into the hand. This nerve provides sensation to the hand and controls the thumb muscles. Along with the flexor tendons to the fingers, the nerve passes through a tunnel at the wrist, made up of wrist bones and a thick band of fibrous tissue on top.

Any increase in pressure within this space reduces blood flow to the median nerve, impacting its function and causing numbness, tingling, and burning pain in the hand. Out of every 1000 people, 3-5 will develop carpal tunnel syndrome in their lifetime.

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How Do I Know I Have it?

If you have hand numbness, tingling or burning pain in the thumb, index, middle or ring fingers you may have carpal tunnel syndrome. These symptoms usually are worse in the morning after waking up and may sometimes wake you up from sleep.

Gripping an object tightly, using a mobile phone or holding up a newspaper can also trigger these symptoms. Tingling, pain, and stiffness are worse when the hands are cold and better when warm. Shaking the hands vigorously usually relieves the symptoms. Over time, the ability to feel becomes worse. It may feel as if there is a layer between the skin and the object making it harder to feel it properly. The thumb muscles may become weak and waste away, resulting in difficulty performing simple tasks like doing up buttons or picking up coins.

It is important to see a hand surgeon to get the right diagnosis and hand numbness treatment if you have numbness or tingling in the hands. Your hand surgeon may order a nerve conduction study, ultrasound scan or MRI of the hand to help confirm the diagnosis.

Other nerve compressions can cause numbness or pain in the hands, such as cubital tunnel syndrome (ulnar nerve compression at the elbow) and pronator tunnel syndrome (median nerve compression in the forearm). These less common conditions may be misdiagnosed as carpal tunnel syndrome resulting in the wrong treatment.

When to See a Doctor or Hand Specialist?

If you have persistent signs and symptoms suggestive of carpal tunnel syndrome, especially if they interfere with your normal activities and sleep patterns, see your doctor. If you leave the condition untreated, nerve and muscle damage can occur.

What Causes Carpal Tunnel Syndrome?

As we age, the pressure in the carpal tunnel increases due to thickening of the tendons from repeated daily use, leading to hand numbness. Other conditions such as wrist fractures, gout, or tumours may also increase the pressure in this tunnel.

Carpal tunnel syndrome is also commonly associated with frequent repetitive work using the hands for long hours. Production line workers and homemakers, and those who work long hours at the computer keyboard with poor posture are at greater risk.

Pregnant women are also susceptible due to water retention. It is also more common among people with diabetes, renal failure, hypothyroidism, and rheumatoid arthritis.

How is Carpal Tunnel Syndrome Treated?

Conservative Treatment

Early or mild carpal tunnel syndrome can be treated by keeping the wrist in a brace especially when sleeping and avoiding postures and activities that increase the pressure around the nerve.

Treatments for Temporary Relief

  • Non-steroidal anti-inflammatory medication
  • High dose Vitamin B6
  • Steroid injections around the nerve
  • Special “nerve gliding” exercises done several times a day can help loosen the median nerve in the carpal tunnel

While conservative treatment is often effective for early and mild cases, it may not work if symptoms, like hand numbness, have been present for several months. In such cases, symptoms may recur after successful treatment.

If there’s no improvement after 2-3 months of conservative care or if symptoms keep recurring, surgery may be necessary. Talking to a specialist will help to ascertain the best treatment for the condition.

Surgery

The fastest and most effective long-term solution for hand numbness treatment in carpal tunnel syndrome is permanent nerve decompression (carpal tunnel release). This involves cutting a thick band of tissue in the palm that is constricting the nerve. It is commonly done with a 3-5cm long incision in the palm which takes about 2 weeks to heal. Pain and weakness can last for 3-4 months, during which use of the hand is limited.

A much less invasive method offered at Hand Surgery Associates is endoscopic carpal tunnel release, an effective hand numbness treatment. This is done through a 7-10mm incision at the wrist, guided by a video camera. Because the cut is so small and not in the palm, the hand can be used for most light activities almost immediately after surgery.

Only 1 or 2 dissolvable stitches are needed, and the wound heals within a week. Pain and weakness are less, and full hand function recovers in half the time.

The scar is barely visible after a few months. Studies have shown that risks of complications are less with this method, when done by experienced surgeons.

In other cases, surgery involves making a larger incision in the palm of your hand over the carpal tunnel and cutting through the ligament to free the nerve, offering a more direct hand numbness treatment.

More than 90% of people with carpal tunnel syndrome can be completely cured by surgery if treated within 6 months of noticing symptoms. Those who have had symptoms for several years may not be completely cured but do improve significantly, resulting in much better sleep and hand function.

Risks of surgery include potential injury to the nerve, which can result in worsening hand numbness, pain, or a sensitive scar, as well as incomplete nerve release, leaving the symptoms unresolved. Some individuals may experience a prolonged recovery, with hand numbness and weakness lasting over 3 months.

However, these complications are rare when performed by experienced hand surgeons. In about 5% of cases, symptoms may return several years after the initial hand numbness treatment surgery.

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Post-Operative Care

After surgery, you are encouraged to gradually increase usage of your hands, working back to normal use, while avoiding forceful hand motions or extreme positions of your wrist. Soreness or hand numbness may take from several weeks to as long as a few months to resolve after surgery. If your symptoms were very severe before surgery, symptoms may take a few months to subside.

Following carpal tunnel release surgery, your hand will remain in a bandage for a couple of days, and you may need to wear a sling. You should keep your hand elevated for 48 hours to help reduce any swelling and stiffness in your fingers.

To help prevent stiffness, gently exercise your fingers, shoulder and elbow. You may be able to start these gentle exercises on the day of your operation.

How Can I Prevent Carpal Tunnel Syndrome?

Maintaining good hand and wrist posture while working long hours on a computer can help prevent hand numbness and reduce the risk of developing carpal tunnel syndrome.

If performing repetitive work for long periods, taking a short break every hour to stretch and loosen the hand and wrist is recommended. Proper management of diabetes and other conditions that increase the risk of nerve compression is also crucial in preventing the need for hand numbness treatment.

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