Is it mandatory to have a surgery if affected by the carpal tunnel syndrome?
No! In the early stage of the disease a conservative treatment is sufficient. An early stage is given if only mild symptoms occure, due to the nerve compression, like paraesthesia during night.
When is it advised to undergo a surgery and when is a conservative treatment useful?
If no improvement is achieved medium-term, a surgery should be considered to prevent an irreversible damage of the nerve. The decision if a surgery is beneficial should be carefully considered. Therefore an experienced neurologist or hand surgeon should be consulted. A surgery is recommended if:
- A permanent loss of skin sensation is given
- Difficulties with handling small objects occur (problems with opening/closing buttons, cannot hold a needle like before)
- Severe pain with frequent waking up during night (over a long period)
- Permanent painful sensation disturbances lasting over a longer period
- Loss in strength of the thumb when pressing the thumb against the fingers
- The thumb ball muscles are shrinking
- A tumour is found in the carpal tunnel
There are several options for the non-surgical (conservative) treatment of the carpal tunnel syndrome:
Which options exists for the non-surgical treatment of the carpal tunnel syndrome?
The most common conservative treatment is the night-resting brace. The brace prevents the wrist from being flexed. Especially in early staged of the carpal tunnel syndrome, this treatment can provide a good improvement regarding symptoms. The illustrations shows such an aid. It should not be worn permanently but only at night.
Is a splint also recommendable for the immobilization?
In principle, this is possible. However it is difficult to apply a forearm split yourself. Therefore a split is only applied short term for a few days, if the patient suffers from severe pain.
The illustration show a splint for the forearm. Hereby the wrist is immobilized. However the finger joints and the thumb joint remain moveable.
Is a cold laser treatment possible for treating the carpal tunnel syndrome?
The carpal tunnel syndrome was one of the first diseases for which the FDA (Food and Drug Administration) approved the cold laser treatment (“Healing light”) as therapy.
Also Lars Hode from the swedish medical society for laser therapy considers the usage of the low-energy laser (so called cold laser) useful for the treatment of the carpal tunnel syndrome.
Which medication in addition to the treatment?
For swelling and pain, additional taking of an anti-rheumatism drug (NSRA) can be considered for (temporary) application.
This drugs may not be taken without consulting the family doctor, as these drugs can have several negative side effects (E.g. danger of developing ulcers in the stomach or bleeding)
Especially in the early stage of the carpal tunnel syndrome, treatment efforts with Vitamin B6 can be useful.
Recently another non-surgical treatment with C-Trac is broadly discussed: What is so special about the treatment with C-Trac?
The treatment with C-Trac is a new and – at least in theory – promising way (US patent number: 6146347):
The roof of the carpal tunnel (transverse carpal ligament) is stretched through controlled pressure. The carpal tunnel expands with repeated Treatment.
Is a therapy with injections possible?
An injection with cortisone can have lead to a significant improvement in case of extensive swelling of the tendon sheaths within the carpal tunnel. In most cases, his improvement does not last long. The injection should only be done by an experienced doctor. There is a risk of damaging the nerve through the injection.
Likewis there is the possibility of an infection as a result of the injection of cortisone, which leads to an emergency surgery.
What can I do to improve my symptoms?
Avoid excessive efforts for the hands. Especially avoid activities, for which it is necessary to stretch or flex your wrist for a longer period of time (e.g. cycling!) If you occupationally work a lot with the keyboard, ensure using a good armrest and having an ergonomically designed work station.
Give your hands (and your body) frequent breaks. You should especially consider this if you are performing fine tasks with your hands including a very high frequency of movements. Getting up from the work station and moving the hands is very helpful.
Short cold or warm water flows, which are moving from the hands to the forearm using a spray lead to a decongestion and therefore to less content in the carpal tunnel.