Treating carpal tunnel syndrome
Treatment for carpal tunnel syndrome (CTS) depends on the severity of the condition and how long you have had it.
In some cases, CTS will improve after a few months without treatment. Moving your hand or shaking your wrist can often help relieve the symptoms.
You should try avoid any activites that make your symptoms worse.
If your work involves using a computer keyboard, there is little evidence that modifications at your workplace are likely to be of any help in relieving your symptoms.
If symptoms persist, there are a range of non-surgical and surgical treatments available that aim to relieve the pressure on the median nerve.
If CTS is caused by an underlying health condition such as rheumatoid arthritis, treating the condition should improve your symptoms.
The various treatments for CTS are outlined below. You can also read a summary of the pros and cons of the treatments for CTS, allowing you to compare your treatment options.
Unless there is thought to be an immediate need for surgery, treatments such as wrist splints and corticosteroid injections are often recommended initially.
There is a lack of evidence to support the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for treating CTS, or for diuretics to help relieve fluid retention.
A wrist splint is worn to support the wrist and keep it in a neutral position. It should not apply direct pressure over the carpal tunnel.
The splint prevents the wrist from bending, which can place pressure on the median nerve and aggravate your symptoms.
You should begin to notice an improvement in your symptoms within four weeks of wearing the wrist splint. Wrist splints are usually available from larger pharmacies, or your GP may be able to recommend a suitable supplier. They can also be ordered online.
Corticosteroids are a type of steroid medication. Steroids are hormones that are naturally produced in the body. They are powerful chemicals that can help reduce inflammation.
If a wrist splint does not work, corticosteroids may be recommended.
Corticosteroids can be taken as tablets, although for CTS it is likely that you will have a corticosteroid injection directly into your wrist.
One injection is usually recommended to begin with. If the condition responds well to one injection but then recurs, the treatment may be repeated.
Carpal tunnel release surgery
Surgery is usually recommended for cases of CTS, when other treatments have failed to relieve symptoms.
Surgery for CTS is known as carpal tunnel decompression or carpal tunnel release surgery and is performed on an outpatient basis, which means you will not have to stay in hospital overnight.
During surgery the roof of the carpal tunnel, known as the carpal ligament, is cut to reduce pressure on the median nerve in the wrist.
A local anaesthetic is used to numb your hand and wrist, but you will remain awake throughout the operation.
The surgery can be performed as open surgery, which involves making a single cut in the wrist, and is the traditional type of operation.
Some surgeons use keyhole surgery, where special instruments and a long tube with a light at one end and an eyepiece at the other are inserted through small cuts in your wrist, and sometimes your palm. This allows the surgeon to see the carpal ligament on a monitor throughout the operation.
There are no long-term differences in the outcomes of the two approaches.
Your surgeon will be able to discuss the most appropriate method of surgery with you.
Things to consider
A number of things may affect your decision to have surgery. These include:
- possible complications after surgery (see below)
- the recovery time
- how successful non-surgical treatments have been
In most cases, carpal tunnel release surgery provides a complete and permanent cure. However, as with any form of surgery there is always a small risk of complications.
Reported complications of CTS include:
- failure during surgery to fully separate the roof of the carpal tunnel, usually resulting in persistent CTS symptoms
- bleeding after the operation
- nerve injury
- persistent wrist pain, which may be different to the original symptoms
- in rare cases, the return of CTS symptoms long after apparently successful surgery
- complex regional pain syndrome – a rare but chronic (long-term) condition that causes a burning pain in one of the limbs
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 raised 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.
After having surgery for carpal tunnel syndrome (CTS), you can use your hand to do light activities that do not cause excessive pain or discomfort. Try to avoid using your hand for more demanding activities until it has completely recovered, which may take several weeks.
The recovery time for open release surgery is usually slightly longer than the recovery time for keyhole surgery. Studies have also shown that there is less pain during the first three months after keyhole surgery compared with open release surgery. However, both methods have proven to be equally effective in treating CTS.
CTS during pregnancy
If you develop CTS during pregnancy, your symptoms should pass after your baby is born (after about six to 12 weeks).
However, if the median nerve is severely compressed (squashed) or if the symptoms of CTS are chronic (long-lasting), permanent nerve damage and muscle-wasting can occur and treatment will be required.
Page last reviewed: 18/09/2014
Next review due: 18/09/2016