Generally, the
standard course of treating Carpal Tunnel Syndrome ("CTS")is to
begin with the least disruptive and least expensive options, proceeding,
as necessary to more involved procedures. Conservative treatment, going
next to medical treatments, and using surgical treatments only in the
most extreme cases.
CONSERVATIVE TREATMENTS
The primary
purpose of conservative treatment is to allow the ailing tissue or nerve
to heal itself. The three most common forms of conservative treatment
include:
-
Wrist Splint- For Carpal Tunnel
Syndrome and other Repetitive Stress Injuries involving the hand and
wrist, many doctors prescribe a splint to immobilize the injured area
and allow it recover. The splint keeps the wrist in a neutral
position, allowing the opening of the carpal tunnel and the passageway
for the ulnar nerve to remain as large as possible.
Another type of splint for "CTS" consists of a
stiff, straight piece that rests against the back side of your lower
forearm and hand. Elastic straps at both ends effectively immobilize
your wrist, but allow you considerable freedom of movement with your
hand and fingers, an advantage over other splints. This is a
relatively new approach but many people with "CTS" who have tried it
report that it seems to work well.
Whenever immobilization is used, there are three
things to be concerned about. First, your muscles may lose their tone.
This is usually not serious if the period of immobilization is just a
few weeks, since you will regain muscle tone quickly with exercise.
Second, joints can be overcome quickly with exercise. Finally, anyone
wearing a splint and trying to continue to do their job can instead
aggravate their condition.
-
Hot
and cold Compresses are sometimes used
as part of conservative treatment. Cold should be applied soon after
swelling occurs to reduce the swelling and to allow as much mobility
as possible in the affected area.
Heat can increase blood flow in soft tissue such
as muscles and tendons and aid in healing and reducing pain or
discomfort. If an area is swollen, heat should be avoided since
increased blood flow can add to the swelling.
-
Exercise and physical therapy are
useful only after your condition has been stabilized and the injured
tissue is recovering. Even then, they should be done only under
supervision of a physical therapist or another health professional.
Generally, exercises stretch your muscles and
tendons, improve blood circulation, reduce muscle tension and improve
joint motion. It is always a good idea as a preventive measure to
exercise before you start work and periodically through the working
day.
MEDICAL TREATMENTS
Many doctors
prescribe medicine for "CTS" and consider medical treatment a type
ofconservative treatment. There are several medical treatments that are
used primarily to reduce inflammation which allows damaged tissue to
heal, including:
-
Aspirin and ibuprofen often are
recommended because both reduce swelling of inflamed tissue and
relieve pain. In addition, they are inexpensive and readily available.
For many "CTS" cases, immobilization, rest, and one of these
anti-inflammatory painkillers is sufficient for full recovery.
Ibuprofen is a nonprescription type of nonsteroidal anti-inflammatory
drug (NSAID).
-
Corticosteroids can be injected
directly into inflamed tendons and bursa. Because the drug is
delivered directly to the site, it can produce dramatically quick and
significant reductions in swelling, often within forty-eight hours.
Some patients initially feel worse, but most feel better quickly.
Success depends primarily on accurate location of the damaged tissue.
SURGICAL TREATMENTS
Some advanced
cases of "CTS" must be treated surgically or the nerve damage will
continue to worsen.
What is most
difficult is deciding when surgery must done. Many hand surgeons
recommend carpal tunnel release surgery without hesitation. As
operations go, it is simple, the risks of complications are small, and
the chances of success are good. There is some concern that the long
term results of carpal tunnel surgery may be less than glowing, however.
The
objective of carpal tunnel surgery, or carpal tunnel release, is to
sever the carpal ligament, a tough
connective tissue that crosses the wrist at the base of the hand. (It is
know medically as the flexor retinaculum.) The primary purpose of the
ligament is to hold in place the tendons that pass through the wrist's
carpal tunnel along with the median nerve. Since "CTS" is the result of
compression of the median nerve by the tendons, it seems logical to
relieve pressure on the nerve by effectively unbanding the area (see
graphic).
The
traditional surgical method in use for more than four decades is known
an open carpal tunnel surgery. An incision of about two
inches is made through the skin covering the carpal ligament. The
ligament is then severed.
More
recently, surgeons have developed a "closed method" called
endoscopic surgery, a procedure that allows the doctor to see
and operate inside your palm and wrist through very small incisions. The
surgery is done through one or two small incisions using a thin,
telescope-like instrument called an endoscope. A video camera attached
to the endoscope records images that your surgeon can view on a monitor.
During the
surgery, using specially designed surgical tools, your doctor cuts
(releases) the transverse carpal ligament. This increase the tunnel
space so that the median nerve is no longer under pressure. The entire
surgical procedure generally takes less than an hour, and is usually
performed on an outpatient basis. Because a large incision is avoided,
endoscopic surgery may cause less pain and allow for faster healing than
the traditional "open surgery."
While open
surgery often keeps the patient from returning to work for as long as
several months, the majority of patients who undergo the endoscopic
release are able to return to work within a week to ten days.
