Conventional Treatment And Lifestyle Changes
The treatment of CTS is dictated by the cause, duration, and amount of compression of the median nerve. If the disease is secondary to another problem, such as arthritis or gout, treatment of the primary condition will often resolve the CTS.
In most cases caused by repetitive stress or whose cause is unknown, treatment usually relies on a combination of medications and lifestyle changes, such as splinting and avoidance of activities that aggravate the condition. Splints, available in pharmacies, may be helpful in milder cases. They keep the wrist extended and allow limited use of the fingertips.
Physicians may prescribe non-steroidal anti-inflammatory drugs (NSAIDs) to reduce pain, diuretics to relieve pressure, and vitamin B6. There is controversy, however, over the effectiveness of NSAIDs, which also have potentially serious side effects, and diuretics. While NSAIDs are effective for short-term flare-ups, long-term results with NSAIDs have been poor (Wilson 2003). Oral steroids may also be prescribed (Chang 1998).
For people who don't respond to the initial treatment, injections of corticosteroids directly into the carpal tunnel may be recommended. Newer research has shown that a single injection of methylprednisolone, at doses up to 60 mg, may be effective at long-term relief and that a second injection may not be necessary (Wong 2005; Dammers 2005). A single injection is best because it avoids the complications associated with corticosteroid injections, including nerve damage and relapse.
In the most severe cases, surgery to relieve pressure in the carpal tunnel is also an option. During surgery, the carpal ligament (the “roof” of the carpal tunnel) is surgically separated to relieve the pressure. Alternatively, the procedure can be performed endoscopically to reduce recovery time and the size of the surgical wound.
For moderate cases, in which surgery isn't required, or for patients who haven't responded to aggressive medical intervention or surgery, two additional treatments, low-level laser acupuncture and transcutaneous electrical nerve stimulation, may be recommended. They are often used together. During low-level laser acupuncture, a red laser penetrates the shallow acupuncture points of the hand. A trained acupuncturist or doctor must perform this procedure. Additional acupuncture points may be treated on the forearm or up to the shoulder area, according to the distribution of radiating pain (Branco 1999).
In addition to medication and surgery, people with CTS can use a number of strategies to improve their condition, including the following:
- Take more frequent breaks from the pain-causing movement.
- Wear wrist splints at work or at home at night during sleep. Wearing splints at night is important because fluid redistributes throughout the body while people recline, increasing in volume in the upper part of the body and producing increased pressure in the carpal tunnel.
- Wear a forearm brace, a narrow cuff worn just below the elbow that reduces fluid content in the carpal tunnel.
- Use cooling pain gel on the wrist. Many of these gels contain methylsalicylate, an aspirin-like substance. Before regular use, consult with your physician about possible drug interactions.
- Have someone massage your neck, shoulders, and back to relieve tension in the forearm and wrist.
- Use a wrist rest in front of your keyboard and keep your keyboard level, not elevated, at your computer workstation.
- Some larger companies offer ergonomic consultation for their employees (Morse 1986). If it is available, make use of it.