Treatment Options for Carpal Tunnel Syndrome

Carpal Tunnel Treatment

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Carpal tunnel syndrome treatments have been carefully studied, so there is a lot of information about how to best treat carpal tunnel syndrome.  In general, patients should try simple treatments first, and if they are ineffective, progress to more invasive treatments. 

The first step in knowing how to treat carpal tunnel syndrome is ensuring the proper diagnosis has been made.  Fortunately, the signs of carpal tunnel syndrome are very consistent, and a careful examination should allow your doctor to make a proper diagnosis.

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Anti-Inflammatory Medications

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Anti-inflammatory medications or NSAIDs (e.g. Motrin or Advil) can decrease inflammation in the carpal tunnel and can also decrease carpal tunnel syndrome symptoms.  Often an effective, and simple treatment, NSAIDs can be an easy way to find effective relief from mild or moderate symptoms of carpal tunnel.

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Night Splints

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The brace helps to stabilize the carpal tunnel in its neutral position. The carpal tunnel is at its widest diameter in this position and the nerve is least compressed. Wearing the splint at night is especially important, as well as during activities that tend to irritate your carpal tunnel syndrome.

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Cortisone Injections

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A cortisone injection works by delivering a powerful anti-inflammatory medication directly to the source of the problem. Steroids shoulder be injected sparingly, and if the carpal tunnel syndrome returns, surgery may be considered. 

Injections of cortisone into the carpal tunnel work about 80% of the time. However, this relief may be temporary, and the symptoms may return. Recent research has shown that the carpal tunnel injection is probably an effective treatment for at least one year in many patients. The injection can also be very helpful in situations where the diagnosis of carpal tunnel syndrome is unclear.

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When symptoms of carpal tunnel syndrome fail to improve despite appropriate treatment, surgery may be an option. Surgical treatments are effective in the treatment of carpal tunnel syndrome. The most common procedure is the carpal tunnel release. A carpal tunnel release involves making an incision in the ligament that forms the top of the carpal tunnel. By releasing tension in the carpal tunnel, the pressure is removed from the nerve.

If a carpal tunnel release is done, it is most commonly performed by a "open" surgery. To perform an open carpal tunnel release, your surgeon makes a 3-4 centimeter incision down the middle of the palm. Your surgeon carefully dissects the tissues down to the carpal tunnel. The carpal tunnel is opened up to relieve the pressure on the nerve. The surgery only takes about 10 to 15 minutes, and can be performed under local, regional, or general anesthesia.

The most common complications of surgical release of the carpal tunnel are problems with pain in the palm of the hand in the area of the incision. Infection is also a possible complication, and it is important to follow your surgeons instructions to keep the wound clean while it is healing. Nerve injury is an uncommon, but serious complication. Nerve injury usually results in an injury to one of the branches of the median nerve. This may lead to weakness of the thumb.

Minimally Invasive Surgery

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A carpal tunnel release can also be done through a minimally invasive incision with a camera called an endoscope. In this procedure called an endoscopic carpal tunnel release, a small (about 1 centimeter) incision is made by the wrist. Through this incision, a small camera is inserted into the carpal tunnel. A small knife attached to the camera is then used to release the carpal tunnel.

Both "open" surgery and endoscopic surgery are effective in the treatment of carpal tunnel syndrome. Many surgeons prefer the open carpal tunnel release because it is easy to ensure there is adequate relief of tension around the nerve. Furthermore, by seeing the nerve, there is a comfort surgeons have in ensuring the nerve is not injured.

That said, the most common complications from carpal tunnel surgery are because of an incision in the palm of the hand. The endoscopic surgery has fewer problems with incisions, and therefore some surgeons prefer this minimally invasive technique. It is important that no matter what procedure is performed, it is done by a surgeon with experience in the technique they prefer.

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Alternative Treatments

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Many patients seek out alternative treatment options for treatment of their medical condition, especially when they may be facing more invasive traditional treatments.  While it is true that side-effects from many alternative treatments are minimal, there is also good evidence to show many of these alternative treatments are not particularly helpful.

There has been good scientific studies on many treatments for carpal tunnel.  Some treatments have been shown to be beneficial, but not as beneficial as the aforementioned treatments (ultrasound).  Other treatments have failed to show benefit for treatment of carpal tunnel syndrome (acupuncture).

As mentioned, many alternative treatments have few side-effects, and if patients are interested, they should discuss these treatments with their doctor to ensure there is no need to proceed with more urgent treatment.

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