Treatment

Treatment for carpal tunnel syndrome (CTS) depends on the severity of the nerve damage and your preferences. In some cases, CTS improves after a few months without treatment.

You should try to avoid any activities that make your symptoms worse.

If your work involves using a computer keyboard, there's little evidence that modifications at your workplace are likely to be of any help in relieving your symptoms.

If symptoms persist, there are a range of non-surgical and surgical treatments available thataim to relieve the pressure on the median nerve.

If CTS is caused by an underlying health condition, such as Rheumatoid arthritis , treatingthe condition should improve your symptoms.

The various treatments forCTS are outlined below. You can also read a summary of the pros and cons of the treatments for CTS , allowing you to compare your treatment options.

CTS during pregnancy

If you develop CTS during pregnancy, your symptoms should pass after your baby is born after about6 to 12 weeks.

However, if the median nerve is severely squashed (compressed) or the symptomsare long-lasting (chronic), permanent nerve damage and muscle wasting can occur and treatment will be required.

Non-surgical treatments

Unless there's thought to be an immediate need for surgery, treatments such as wrist splints and corticosteroid injections are often recommended initially.

There's a lack of evidence to support the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofento treat CTS, or for diuretics to help relieve fluid retention.

Wrist splints

A wrist splint is worn to support the wrist and preventit bending. Bendingplaces pressure on the nerve and aggravates symptoms.

You should begin to notice an improvement in your symptoms within four weeks of wearing the wrist splint.

Wrist splints are usually available from larger pharmacies, or your GP may be able to recommend a suitable supplier. They can also be ordered online.

Steroids are hormones produced naturally in the body. They are powerful chemicals that can helpreduce inflammation.

If a wrist splint doesn't work, corticosteroids may be recommended.

Corticosteroids can be taken as tablets, although for CTS it's likely that you'll have a corticosteroid injection directly into your wrist.

One injection is usually recommended to begin with. If the condition responds well to one injection but then recurs, the treatment may be repeated.

Carpal tunnel release surgery

Surgery is usually recommended for cases of CTS when other treatments have failed to relieve symptoms.

Surgery for CTS is known as carpal tunnel decompression or carpal tunnel release surgery,and is performed on an outpatient basis, which means you won't have to stay in hospital overnight.

During surgery, the roof of the carpal tunnel (carpal ligament) is cut to reduce pressure on the median nerve in the wrist.

A local anaesthetic is used to numb your hand and wrist, but you'll remain awake throughout the operation.

The surgery can be performed as open surgery, which involves making a single cut in the wrist.

Some surgeons use keyhole surgery, where special instruments and a long tube with a light at one end and an eyepiece at the other are inserted through small cuts in your wrist, and sometimes your palm.

This allows the surgeon to see the carpal ligament on a monitor throughout the operation.

There are no long-termdifferences in the outcomes of the two approaches.

Your surgeon will be able to discuss the most appropriate method of surgery with you.

Things to consider

A number of things may affect your decision to have surgery, including:

• possible complications after surgery
• the recovery time
• how successful non-surgical treatments have been

In most cases, carpal tunnel release surgery provides a complete and permanent cure. However, as with any form of surgery there's always a small risk of complications.

Reported complications of CTS include:

• infection
• failure to fully separate the roof of the carpal tunnelduring surgery, usually resulting in persistent CTS symptoms
• bleeding after the operation
• nerve injury
• scarring
• persistent wrist pain, which may be differentfrom the original symptoms
• in rare cases, the return of CTS symptoms long after apparently successful surgery
• complex regional pain syndrome a rare but chronic condition that causes a burning pain in one of the limbs

After surgery

There are a variety of different recommendations for postoperative care. There's no evidence that one wayis better than another, but your surgeon will give you advice.

The most common advice after carpal tunnel release surgery is to keep your hand in a bandage for a couple of days, and you may need to wear a sling.

You should keep your hand raised for 48 hours to help reduce any swelling and stiffness in your fingers.

Gently exercise your fingers, shoulder and elbowto help prevent stiffness. You may be able to start these gentle exercises on the day of your operation.

After having surgery for CTS, you can use your hand to do light activities that don't cause excessive pain or discomfort.

Try to avoid using your hand for more demanding activities until it's completely recovered, which may take several weeks.

The recovery time for open release surgery is usually slightly longer than the recovery time for keyhole surgery. However, both methods have proven to be equally effective.