Carpal Tunnel Syndrome

What non-surgical (conservative) treatment options are available?

Symptoms of CTS can often be relieved with non-surgical treatments, but the only scientifically proven disease modifying treatment is surgery. Non-surgical treatment of CTS is primarily for those with mild symptoms with no signs of nerve damage or muscle loss, those who have just been diagnosed with CTS and are either attempting a conservative trial of therapy or seeking symptomatic relief prior to surgical intervention, and those who for some reason are not a candidate for operative repair. Non-surgical treatments of CTS aim to relieve and reduce symptoms to allow the patient to function normally in their activities or occupation. Any associated medical conditions need to be treated appropriately. The primary goals are to reduce inflammation and prevent aggravating activities and situations. The effectiveness of non-surgical treatments of CTS is dependent on the level of severity. There are a variety of non-surgical treatment modalities available that are discussed below.

Treatments to Reduce Inflammation

•Nonsteroidal anti-inflammatory drugs (NSAIDs) may help with short-term symptom relief, but have not been shown to treat or improve CTS.

•Corticosterioids (injections and oral administration) have been used in an effort to reduce inflammation secondary to their powerful anti-inflammatory properties. Injection is preferred over oral administration because of the potential side effects related to systemic availability and distribution. This treatment is usually reserved as a last resort non-surgical treatment modality. Symptom relief is also only temporary and repeat treatments are required.

•Ice and elevation may help with symptom relief, but does not treat the cause of CTS.

•Alternative treatments such as yoga, hand therapy with occupational/physical therapists, and ultrasound therapy are available options but have not been proven scientifically to work. They may help with symptom relief. Be sure to let your physician know if you are participating in or receiving any of these treatments.

Treatments to Prevent Aggravating Activities

•Rest and activity restriction/modification is often utilized to reduce symptoms. There is no proven preventive strategy for CTS. Strategies to reduce activities and behaviors that aggravate the condition can help once one has CTS. In fact, studies show significantly stronger causal association with biological factors than occupational/environmental factors, suggesting CTS may not be preventable with reduction or avoidance of work/activities. Taking frequent breaks from aggravating activities may help. Additionally the use of office ergonomics (keyboard wrist rests, mouse pads) may help, but consumers must be careful because there is no regulation of products claiming to be ergonomic.

•Wrist splinting is one of the earlier attempted treatment modalities for CTS and assists to decreases movements and postures which aggravate the symptoms. Currently they are best used at night to help with nighttime symptoms. Splints usually work better for patients who have only experienced mild to moderate symptoms for only a short time (months). While splinting may provide symptom relief, they do not address the actual problem.

 

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Additional Information

Please see the provided Additional Links and Resources about Carpal Tunnel Syndrome for additional information and references.