In the 1950s surgery was the only recognized course of treatment for carpal tunnel syndrome. It was a serious and complicated procedure, with an incision made from the palm and continuing all the way to the end of the fingertips. This surgery was followed by a recovery that could take many months. Fortunately, today there are many alternatives available.
Once your physician has been able to evaluate just how serious your condition is, various possible treatments can be considered. An immediate first step is to discontinue immediately those activities that aggravate the symptoms. In reviewing treatment options, the most prudent philosophy is to first consider the most conservative, least invasive procedures. Then, if necessary, begin looking at the more progressively complicated treatments.
Carpal tunnel syndrome will go away by itself in some cases, usually when the disorder has not progressed beyond early, mild symptoms. All that is required is simply not doing anything other than to completely refrain from any injurious activities.
When relatively minor symptoms of carpal tunnel syndrome are present, splinting can be an effective method of treatment. Sometimes splints are worn only at night, with the hand and wrist splinted in a neutral position or at a maximum extension of fifteen degrees. In other instances, the splint may be worn at all times. After approximately two or three weeks of wearing a splint, the patient’s condition can be reevaluated.
Do rely on your doctor or physical therapist to fit and prescribe the usage of a splint. It is not a good idea to buy a splint from a mail-order catalog or drugstore without medical supervision. Using splints improperly can cause symptoms of carpal tunnel syndrome to migrate. There have also been instances where patients have worn splints and continued to type, which has resulted in the atrophy of some muscles and the overuse of others.
The use of nonsteroidal anti-inflammatory drugs (NSAIDs) can decrease the inflanmiation and pain and allow the damaged tissue to heal. Use of NSAIDs such as fenoprofen or ibuprofen, along with rest and splinting, can result in complete and full recovery. However, especially for patients over forty, there can be serious side effects from the overuse of NSAIDs, including fever, nausea, ulcers, bleeding, chills, headache, kidney problems and stomach cramps.
The use or cortisone steroid injections, which travel directly into the carpel tunnel often produces dramatic results, with significant reductions in the pain and inflanmiation of carpal tunnel syndrome in fewer than forty-eight hours. There are serious drawbacks and concerns with this treatment, though, and many physicians strongly oppose the use of steroid injections. Its success depends on extreme accuracy in locating the damaged area. If the injection misses the target, there is little or no result at all; however, if there are repeated injections into the same tendon, there is the possibility of rupturing the tendon.
The painful symptoms of carpal tunnel syndrome can be relieved with aspirin, although it should not be used with an NSAID. There are side effects associated with aspirin, which can interact with other drugs, so be sure to discuss its suitability with your doctor.
Tylenol and other acetaminophens are aspirin substitutes for pain relief that generally do not cause the side effects that aspirins do. Again, check with your doctor before including them in your treatment plan.
When the condition has progressed to an advanced state and there is a danger of continued nerve damage, surgery is most often recommended. In cases where the pain is relentless and severe and where the thumb has begun to atrophy, surgery is nearly always indicated. Although the surgery is relatively simple and carries little risk of serious complications, it’s always wise to get a second opinion from a qualified hand surgeon before deciding to have the procedure.
The objective of surgery is to create more room in the carpal tunnel and thereby release pressure on the median nerve. This is accomplished by dividing the transverse carpal ligament so that it no longer compresses the median nerve as it passes between the ligament and the carpal bones. In some advanced cases, where the lining of the nerve has thickened, it is also necessary to remove scar tissue from the nerve and the lining.
Open carpal tunnel surgery is the traditional method that has been used for nearly fifty years. An incision of approximately two inches is made through the skin covering the carpal ligament, which is then severed. Healing time is about four to six weeks. In recent years, an alternative method using fiber optic tools has been very successful. This “closed,” or endoscopic, method involves a smaller incision that is made across the forearm near the base of the hand. Recovery time for this method is about half that of the traditional approach.
There is a new technique, similar to the balloon angioplasty used to open clogged arteries, that has recently been employed in treating carpal tunnel syndrome. A small incision is made at the base of the palm, under the ligament. When the balloon is inflated, it stretches the ligament rather than cutting it and creates additional room for the nerve.
Once the condition has been arrested and the damaged tissue is healing, physical therapy can be beneficial. A physical therapist will utilize deep tissue massage to break down scar tissue, which binds together muscles that ordinarily would operate independently; massage also separates the scar tissue from muscle tissue. Other techniques that are used in physical therapy are heat treatments, stretching, ultrasound and vibrating massage to achieve flexibility in the muscles and tendons.
Some of the alternative treatments for carpal tunnel syndrome that are widely utilized concentrate on reducing the pain associated with the symptoms. Other therapies focus on the prevention of new or additional symptoms.
The utilization of acupuncture treatments will increase the production of endorphins, the natural painkillers produced by the body, and relieve the painful symptoms of carpal tunnel syndrome. Such treatments also promote a beneficial effect on the healing of the median nerve.
A carpal tunnel syndrome patient can benefit from a vitamin regimen in several ways. During the recovery period following surgery, vitamin C can help in the healing process, while vitamin E has been found to minimize soreness and inflammation. However, the vitamin that has created quite a stir as an agent of treatment for carpal tunnel syndrome is vitamin B. Specifically, B6 in a dosage of 300 mg daily for three months has been found to be highly beneficial. It is believed that B6 works to strengthen the sheath that surrounds the tendon and so relieves the pain. B6 treatment is even more effective when it is combined with B2, B12, and folic acid. Recommended dosage is 100 mg daily of B2, 1,000 meg of B12, and 800 meg of folic acid. After three months, you should reduce the B6 dosage to between 50 and 100 mg daily as a maintenance level. It is important to not take more than the recommended amount, because B6 can be toxic at high levels.
An effective method of easing the pain of carpal tunnel syndrome is acupressure. Before beginning the procedure, be sure that you are sitting comfortably and have located points P7 on the inside of each arm in the middle of the wrist and TW4 on the outside of the arm in the hollow at the center of the wrist. You can work on the two points at the same time, by placing your left thumb on the TW4 point of the right wrist and the left fingers on the P7 point of your right wrist. Press those points for a few minutes and then switch sides. This procedure can be repeated several times during the day.
A Shiatsu form of acupressure, which involves rhythmic pressing for short periods of three to ten seconds, is also effective in countering painful symptoms of carpal tunnel syndrome. In this method, all the fingers are placed on the outside of the forearm, with the thumb on the inside. Begin at a spot about three inches upward from where the crease in the wrist is located. Press on both sides of the bone structure for about ten seconds, then release. Then, move thumb and fingers about a half inch up the arm and repeat. Continue to do this at half-inch intervals up the arm to the elbow. This treatment can be done on both arms several times a day.
The Alexander Technique
Many people who suffer from carpal tunnel syndrome can benefit from the Alexander Technique, which develops an awareness of how stress has stifled and inhibited natural body movement. This technique has helped patients to unlearn poor posture habits and to relearn their natural, innate posture, developing a new awareness of the head, neck and entire body, and learning balanced alignment and automatic movement.
The Feldenkrais Method
Practitioners of the Feldenkrais Method believe that the body is able to extend its range of motion and increase overall flexibility and coordination by releaming and reprogramming basic movements. The technique centers around the belief that the skeletal and muscular structures of the body can be trained to move with a minimum of energy and tension, in more natural and healthful ways of balance and movement. As a result, there will be improved technique at the keyboard for computer users, reducing the amount of uneven pressure utilized in striking the keyboard.
The painful joints that are associated with carpal tunnel syndrome, particularly joints that are hot and swollen, may be relieved through homeopathy. Often prescribed by homeopaths are bryonia and also rhus toxicodendron. For achy muscles, cimicifuga is recommended.
Tension in the hand and wrist can be eased by utilizing a technique of progressive relaxation that is quite simple. Begin by clenching one fist as tighdy as possible and hold it that way for about ten seconds before releasing it instantly and completely. Next, do the same thing with the other fist. Finally, repeat the procedure clenching both fists at the same time. It is recommended that this technique be undertaken before beginning work and then after every break.
During the most acute phase of carpal tunnel syndrome, hydrotherapy can provide much relief, particularly with the utilization of a contrasting bath of hot and cold that improves circulation and reduces swelling. One method is to fill two basins, one with hot water and the other with cold water. First soak your hand and forearm for one minute in the cold water, then soak it for three minutes in the warm. Repeat several times, ending with a cold bath.
A very specific procedure for treating carpal tunnel syndrome, the myofascial technique involves a combination of stretch and direct pressure. By stretching out the ligaments and tendons surrounding the carpal tunnel, this method is effective in treating mild to moderate cases of carpal mnnel syndrome. However, the technique is not recommended for severe cases. In the procedure, a practitioner first holds the patient’s arm out in front with the palm facing up and pulls the thumb back towards the body. Then, the thumb is used as a lever, being pulled and at the same time extended down towards the floor; this process tugs on the ligament and stretches it out.
In coping with carpal tunnel syndrome, you need to concentrate on several phases of treatment. First, there is the immediate need to repair the damage and rehabilitate the injured area. The severity of the damage will greatly influence the choice of which treatment to utilize. It is important to discuss every aspect of the various stages of treatments with your doctor, who can advise you how best to combine traditional and alternative therapies.
Once the injury is stabilized, various treatments can be utilized to strengthen the ligaments and muscles. Finally, the cycle of injury and healing must be broken by concentrating on ways to prevent new injury. You will probably need to re- train yourself and leam new methods of performing those activities that originally provoked carpal tunnel syndrome.
Prevention programs include examining and redesigning tools and equipment; retraining body posture and positions to eliminate awkward stances that are damaging; building in regular breaks from doing repetitive tasks; learning and regularly doing special exercises for stretching and strengthening.