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Carpal Tunnel Syndrome

How Is CTS Treated?

Tuesday, March 20, 2012 - 17:52

Contributing Author: Guy Slowik FRCS

Continued compression on the nerve can cause increasingly severe symptoms and can ultimately damage the nerve. This can permanently impair some of the functions of the hand. For this reason, treatment is important.

Proper treatment can control or cure CTS and prevent permanent disability. Depending on the severity of CTS, conventional treatment may involve some or all of the following measures.

The type of treatment will depend on how severe the symptoms are. They include:

In addition, the doctor may recommend specific exercises to stretch and strengthen the wrist and associated parts.

If conventional treatments fail, surgery may be considered.

Wrist Splints

splint is a device that prevents a joint from bending. Wrist splints keep pressure off the median nerve by preventing the palm from bending forward. There are several types of splints:

  • Neutral splints, which keeps the wrist straight.
  • Cock-up splints, which holds the wrist in a slightly extended position, that is, bent slightly upwards. For many people, these splints are particularly helpful when used at night, for driving, and during other activities that would force the wrist to bend forward.
  • Job-specific splints, such as custom-made splints for people in particular occupations.

A splint should not be worn all day, as this could lead to further muscle weakness and a worsening of symptoms. Remove the splint for a while every four to six hours. It is important that the splint fit properly, and that all the fingers can move freely

Physical Therapy

The doctor or a physical therapist can custom-tailor an exercise regimen for a person with carpal tunnel syndrome. Physical therapy also may involve pain-relief measures such as:

  • Moist heat
  • Ice packs
  • Ultrasound or TENS (transcutaneous electrical nerve stimulation), which involves placing electrodes of the surface of the skin to help block pain impulses

Anti-Inflammatory Medications

Anti-inflammatory medications, known as NSAIDs (non-steroidal anti-inflammatory drugs), are commonly prescribed to manage CTS. Many are available over the counter, including ibuprofen, naproxen and others. Of the newer anti-inflammatories introduced a few years ago, known as COX-2 inhibitors, with supposedly significantly fewer side effects, Vioxx (rofecoxib) was recently withdrawn as it was unfortunately found to have previously unrecognized very significant cardiovascular side effects. Celebrex (celecoxib) remains available.

NSAIDs can cause stomach upset and prolonged use can even lead to stomach bleeding. Taking the medication with food can minimize these side effects.

Diuretics

Known also as "water pills," diuretics reduce fluid retention in the body and may help CTS in cases where excess fluid aggravates symptoms (in some women during their menstrual cycle, for instance).

Steroid Injection Into The Wrist

A steroid solution may be injected directly into the carpal tunnel if symptoms have not improved with simple measures. This does not cause the undesirable effects commonly associated with long-term steroid use. The relief may be permanent or temporary.

Nice To Know:

Oral steroids may help when CTS is caused by rheumatoid arthritis, but should not be taken for CTS caused by repetitive strain or excess fluid in the body. The use of oral steroid for CTS, which is very rarely prescribed, must be carefully monitored by the physician

Alternative Treatments

Some people may find these alternative treatments helpful in conjunction with conventional therapies. They have not been shown scientifically to be helpful.

  • Cold Laser Therapy, Noninvasive, low-energy ("cold") laser light is used to penetrate the skin and soft tissue. The process stimulates the nerve and increases circulation in the wrist without the need for cutting the skin.
  • Acupuncture. This is an ancient Chinese treatment in which the acupuncturist inserts very fine needles into points on the body. Acupuncturists believe that energy flows through the body along pathways called meridians. If something interrupts the energy flow, pain or illness can result. The needles are thought to stimulate energy flow. Although there may be slight discomfort when the needles are inserted, many people find great relief when acupuncture is done by a qualified professional. Sometimes only one treatment or a very few treatments are needed.
  • Vitamin B6 (pyridoxine). Some researchers claim that vitamin B6 relieves CTS. It is not advisable to take more than 200 milligrams per day (including the amount in your multivitamin). More than this amount can cause nerve damage. Vitamin supplementation should be part of an overall plan of balanced nutrition. The dose of vitamin B6 should not be increased if it is found to be unhelpful; rather it should be discontinued.
  • Magnet therapy: Some people believe magnets of at least 550 to 850 gauss stimulate blood flow and offer pain relief. (Gauss is a unit of measurement of magnetic strength.) The side of the magnet with negative polarity is fastened against the skin, either with tape, or as part of a splint or wrap. Refrigerator magnets are too weak for medicinal purposes. Do not use strong magnets near computers or any other equipment that stores data electronically, as the data could be erased by the magnetic force.

Carpal Tunnel Syndrome