July 09, 2019

Understanding Treatment Options for Carpal Tunnel Syndrome
Carpal tunnel syndrome is a painful condition that can have negative impacts on the long-term health of your wrist. Whether you're concerned you may have it or just looking for advice to help a friend or family member, this guide will help you discover steps you can take for both prevention and treatment.

What is the Carpal Tunnel?

First, it's time for an anatomy lesson. The carpal tunnel is a passageway located on the palm side of the wrists. It's normally about an inch wide. The carpal bones form the bottom and sides of the tunnel, and the median nerve and flexor tendons run through the tunnel. The top of the tunnel is comprised of connective tissue called the transverse carpal ligament. The boundaries of the carpal tunnel are fairly rigid, and there is very little room for the tunnel to stretch or expand. 

What Are the Major Causes and Symptoms of Carpal Tunnel Syndrome?

This syndrome develops when the carpal tunnel becomes narrowed, placing too much pressure on the median nerve. Narrowing of the tunnel can happen due to swelling of the synovium, a group of tissues that provide lubrication for the flexor tendons and make hand and finger movements easier. 

Repetitive hand motions, including those done by musicians and individuals who regularly use computers, are a major cause of carpal tunnel syndrome. These repetitive movements can aggravate the tendons in the carpal tunnel, causing swelling. Hand and wrist positions that involve extreme flexion or extension for long periods are also a leading cause of this condition. Health conditions such as diabetes, rheumatoid arthritis, pregnancy, and thyroid disorders increase the risk of this syndrome, and women and the elderly are also at higher risk. 

Symptoms of the syndrome typically start gradually and become worse over time. At first, patients might notice some numbness, tingling, or burning in the thumb, index, middle, or ring fingers, and they might experience brief shock-like sensations in these areas. As the syndrome progresses, the painful sensations often travel up the forearm into the shoulder, and patients might have weakness in their hands that makes it hard to perform daily tasks. Some individuals find that they start dropping items due to weakness and numbness.

Is There Any Way I Can Prevent This Condition?

While there are no proven ways to entirely prevent this syndrome, you can take steps to minimize the strain placed on your fingers, hands, and wrists. One of the most effective ways to prevent strain and potential complications is to ensure that you take frequent breaks when doing tasks that involve your hands. Set a timer to remind you to take a break at least once each hour, and try to alternate tasks so that you're not repeating the same exact motion for long periods. 

Try to use proper posture while working, and keep your wrists and hands as relaxed as possible. When you can, opt to use a middle position for your wrists instead of stretching them all the way up or down. Try to use as little force as possible when writing or typing, and invest in adaptive devices and a comfortable computer mouse to minimize strain. Since stiffness and pain are more likely to occur when you're cold, wear fingerless gloves to warm your hands and wrists as needed. 

How is This Condition Diagnosed? 

If you have any of the symptoms listed above, it's important to see a doctor for a proper diagnosis. The earlier treatment is started, the better chance you'll have of making a full recovery.

To evaluate your condition, a clinician will begin by performing a physical examination. During this exam, the doctor will check the strength of your fingers, wrists, hand, and arm muscles, and he or she will also test your sensation and reflexes in these areas. You might be asked to make a fist or perform certain hand movements, and the doctor may gently bend your wrists or tap on the median nerve. Sometimes, you might need to have an x-ray or nerve conduction studies to confirm the diagnosis.

What Treatments Are Available for This Syndrome?

Doctors typically recommend starting with nonsurgical treatments. For example, they may recommend that you stop or modify the activities that are causing your symptoms. Making adaptations to your work equipment is one step that could help, especially if your symptoms are related to your occupation. Other conservative treatments include anti-inflammatory medications and physical therapy. If these treatments don't work, surgical interventions may be necessary. 

Should I Try a Wrist Brace to Ease My Symptoms?

The use of a wrist brace is normally one of the first suggestions that doctors advise for patients with this syndrome. A wrist brace supports the wrist and keeps it properly aligned. You will likely be asked to wear the brace while sleeping; this will prevent you from unknowingly bending your wrists at awkward angles that could increase your pain. Braces can be especially useful for treating the wrist sprain that often comes along with this syndrome, and so you might need to wear the brace during the day as well. 

When choosing a brace, be sure to pick one that is properly sized for your hand, and remember that you should not wear the brace continuously. Physicians generally recommend that you have at least one hour per day without the brace, and it should be removed for physical therapy, exercise, and showering. We recommend the Arrow Splints Wrist Brace as it provides full wrist protection and its universal sizing is proven to work on multiple wrist and hand sizes for both men and women.

What Physical Therapy Exercises Might Help?

Physical therapy is typically offered for mild to moderate carpal tunnel issues. One of the most beneficial exercises for wrist sprain and carpal tunnel pain is a nerve-gliding exercise. Your doctor or physical therapist will demonstrate suitable exercises for your unique situation. These exercises move through a series of positions that help the median nerve move more freely through the narrowed carpal tunnel. You might be asked to use elastic bands or other aids while doing these stretches, and you'll be instructed as to how frequently you should perform them and how many repetitions you should do. It can take months for physical therapy exercises to work, so don't give up if you don't see improvement right away.

What Surgical Options Could I Consider?

If nonsurgical methods have not improved your symptoms after a period of six months or so, your specialist may recommend that you consider a surgical intervention known as carpal tunnel release. This procedure can be performed with local anesthetic, and you may also be given a light sedative to help you feel more relaxed. 

The aim of this procedure is to release pressure on the median nerve. To perform the operation, the specialist will cut the transverse carpal ligament that forms the roof of the carpal tunnel. This increases the space inside the tunnel itself, reducing nerve pressure and alleviating pain. Doctors can complete a carpal tunnel release either as an open procedure or through endoscopic methods. Outcomes for both types of procedure are similar. 

After the surgery, you might experience minor soreness in your palm for a few months. Your grip strength and ability to grasp objects should return within three months to one year following the operation. You will need to wear a splint for several weeks post-surgery, and you may need to limit lifting, driving, and writing activities for a short period.

What Complications Could Occur if This Condition Isn't Treated?

If this syndrome isn't treated promptly, it's possible that you might develop debilitating complications that could impact your work and ability to perform daily tasks. For example, some patients with advanced forms of the condition experience muscle wasting at the base of their thumb, and they might be unable to sense the difference between hot or cold temperatures with the affected hand.


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