What treatment is available for carpal tunnel syndrome?

Generally, your doctor will prescribe a course of treatment for carpal tunnel syndrome which begins with a more conservative approach (depending on the severity of your symptoms).

The initial steps of treating carpal tunnel syndrome commonly include:

• Anti-inflammatory medications- Your doctor may prescribe an anti-inflammatory medication such as Motrin or Advil which will relieve the inflammation in your wrist. 

• Wrist brace or splint- The brace or splint is used to stabilize the wrist to keep the wearer from bending the wrist. This allows the carpal tunnel to widen and reduces the compression on the nerve.  Your doctor may recommend that you wear the brace especially at night or when you are doing activities which involve flexing the wrist.

If your symptoms do not resolve or worsen, your doctor may prescribe a cortisone injection.  The cortisone helps reduce the amount of inflammation around the median nerve.  It is an effective way to treat carpal tunnel syndrome as the cortisone is injected directly into the source of the problem. 

Recent studies have shown that only 20% of the patients receiving a cortisone injection did not get any relief from their symptoms.  Most patients are symptom free for up to one year. 

Notes:   Since cortisone is a steroid it should be used sparingly. 

Surgical Options

If the carpal tunnel syndrome returns after the injection,  you may be a candidate for surgery. There are a few different surgical options for treating carpal tunnel syndrome: 

• Carpal Tunnel Open Release- The surgeon will make an incision down the middle of your palm.  The tissue is carefully dissected down to the carpal tunnel.  The surgeon will then cut through the carpal tunnel to open it up and relieve the pressure on the median nerve.  The whole procedure takes less than 30 minutes and is usually performed under a local or regional anesthetic.

•  Carpal Tunnel Endoscopic Release- This surgical option is done through a small camera.  This is called an endoscope.  The surgeon makes a small incision in the wrist and places the camera through the incision.  A small scalpel is attached to the camera which allows the surgeon to release the carpal tunnel.

• Percutaneous Balloon Carpal Tunnel Plasty – A small incision is made in the palm of the hand and a balloon is inserted in the incision. The surgeon places the balloon between the carpal ligament and the median nerve by a catheter.  Saline solution is used to inflate the balloon which causes the carpal tunnel to stretch, relieving the pressure .on the median nerve.

While the procedures described above are effective in treating carpal tunnel syndrome, the open release is preferred by many surgeons.  The open release ensures adequate relief of the compression on the nerve.  

Complications From Surgery

The most common complications of a carpal tunnel syndrome release is injury to the nerve and discomfort at the incision.  Generally, injury to the nerve occurs in an average of 6% of all surgical releases.  It is not uncommon for a surgical patient to experience pain at the incision site for long periods. 

Post Operative

After undergoing surgery, diminished muscle strength will exist .  Full recovery of muscle strength will take approximately six weeks.  Your doctor may recommend the use of sprints for a short period after surgery.  He or she may also recommend strengthening exercises. 

If severe weakness has not occurred prior to surgery, results post-operatively are generally pretty good.   You should be able to return to your normal activities. 



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