Carpal Tunnel Syndrome (cont.)
How is carpal tunnel syndrome treated?
The choice of treatment for carpal tunnel syndrome
depends on the severity of the symptoms and any underlying disease that might be
causing the symptoms.
Initial treatment usually includes rest, immobilization
of the wrist in a splint, and occasionally ice application. Patients
whose occupations are aggravating the symptoms should modify their
activities. For example, computer keyboards and chair height may
need to be adjusted to optimize comfort. These measures, as well as periodic resting and range of motion stretching
exercise of the wrists can actually prevent the symptoms of carpal tunnel syndrome that are caused by repetitive overuse. Underlying conditions
or diseases are treated individually. Fractures can require orthopedic
management. Obese individuals will be advised regarding weight
reduction. Rheumatoid disease is treated with measures directed
against the underlying arthritis. Wrist swelling that can be
associated with pregnancy resolves in time after delivery of the baby!
Several types of medications have been used in the
treatment of carpal tunnel syndrome. Vitamin B6 (pyridoxine) has
been reported to relieve some symptoms of carpal tunnel syndrome,
although it is not known how this medication works. Nonsteroidal
anti-inflammatory drugs can also be helpful in decreasing inflammation
and reducing pain. Side effects include gastrointestinal upset
and even ulceration of the stomach. These medications should be
taken with food and abdominal symptoms should be reported to the
doctor. Corticosteroids can be given by mouth or injected directly
into the involved wrist joint. They can bring rapid relief of the persistent
symptoms of carpal tunnel syndrome. Side effects of these medications
when given in short courses for carpal tunnel syndrome are minimal.
However, corticosteroids can aggravate diabetes and should be
avoided in the presence of infections.
Most patients with carpal tunnel syndrome improve
with conservative measures and medications. Occasionally, chronic
pressure on the median nerve can result in persistent numbness
and weakness. In order to avoid serious and permanent nerve and
muscle consequences of carpal tunnel syndrome, surgical treatment
is considered. Surgery involves severing the band of tissue around
the wrist to reduce pressure on the median nerve. This surgical
procedure is called "carpal tunnel release." It can now
be performed with a small diameter viewing tube, called an
arthroscope,
or by open wrist procedure. After carpal tunnel release, patients
often undergo exercise rehabilitation. Though it is uncommon,
symptoms can recur.
- Carpal tunnel syndrome is caused by irritation of the
median nerve at the wrist.
- Any condition that exerts pressure on the median
nerve can cause carpal tunnel syndrome.
- Symptoms of carpal tunnel syndrome include numbness
and tingling of the hand.
- Diagnosis of carpal tunnel syndrome is suspected
based on symptoms, supported by physical examination signs, and confirmed by
nerve conduction testing.
- Treatment of carpal tunnel syndrome depends on the severity of symptoms and the underlying cause.
Last Editorial Review: 3/3/2008
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