It is critical to begin treating early phases of CTS before the damage progresses. A conservative approach to CTS, which may include corticosteroid injections and splinting, is the first step in treating this disorder. The conservative approach is most successful in patients with mild carpal tunnel syndrome. If the initial treatment doesn't improve symptoms in 2 to 7 weeks, another treatment or surgery should be tried.
Some patients may start with surgery if there is evidence of nerve damage. Studies suggest that surgery is a better option for severe CTS. Surgery improves function and symptoms better than splinting or anti-inflammatory drugs plus hand therapy over the long term. The improvements last for more than 6 months.
Even among patients with mild CTS, there is a high risk of relapse.
If possible, the patient should avoid activities at work or home that may aggravate the syndrome. The affected hand and wrist should be rested for 2 to 6 weeks. This allows the swollen, inflamed tissues to shrink and relieves pressure on the median nerve. If the injury is work related, the worker should ask to see if other jobs are available that will not involve the same hand or wrist actions. Few studies have been conducted on ergonomically designed furniture or equipment, or on frequent rest breaks. However, it is reasonable to ask for these if other work is not available.
Conservative Treatment Approach
The following conservative approaches have been shown to provide symptom relief in the short term, although their long-term effectiveness isn't yet known:
- Wrist splints
- Injected or short-term oral corticosteroids
Nonsteroidal anti-inflammatory drugs (NSAIDs) may provide short-term relief of symptoms, but have not been found to help the basic problem go away. NSAIDs include common pain relievers such as aspirin and ibuprofen (Advil). Diuretics, magnet therapy, laser acupuncture, vitamin B6, exercise, or chiropractic care also do not help clear up carpal tunnel syndrome. Other approaches being investigated include omega-3 fatty acid supplements.
It is important to treat any underlying medical condition that might be causing carpal tunnel syndrome. For example, reducing inflammation in rheumatoid arthritis or other forms of inflammatory disorders that directly cause CTS is very helpful. Hypothyroidism and diabetes are diseases associated with an increased risk of CTS. The treatments for such diseases may offer some relief for CTS symptoms.
Wrist splints can keep the wrist from bending. They are not as beneficial as surgery for patients with moderate-to-severe CTS, but they appear to be helpful in specific patients, such as those with mild-to-moderate nighttime symptoms that have lasted for less than a year.
Typically the splint is worn at night or during sports. The splint is used for several weeks or months, depending on the severity of the problem, and it may be combined with hand and finger exercises. Benefits may last even after the patient stops wearing the splint.
Corticosteroids (also called steroids) reduce inflammation. If restricting activities and using painkillers are unsuccessful, the doctor may inject a corticosteroid into the carpal tunnel.
In CTS, steroid injections (such as cortisone or prednisolone) shrink the swollen tissues and relieve pressure on the nerve. There is good evidence that they offer short-term symptom relief in a majority of CTS patients. However, in about half of cases, symptoms return within 12 months. Generally a second injection does not provide any added benefit. Another concern with the use of these injections in moderate or severe disease is that nerve damage may occur even while symptoms are improving.
Corticosteroid injections are helpful for pregnant patients, as their symptoms often go away within 6 to 12 months after pregnancy.
Most doctors limit steroid injections to about three per year, because they can cause complications, such as weakened or ruptured tendons, nerve irritation, or more widespread side effects.
Low-Dose Oral Corticosteroids
A short course (1 to 2 weeks) of oral corticosteroid medicines may provide relief for some people, but the relief does not usually last. Long-term use of these medications can cause serious side effects.
Ultrasound uses high-frequency sound waves directed toward the inflamed area. The sound waves are converted into heat in the deep tissues of the hand, opening the blood vessels and allowing oxygen to be delivered to the injured tissue. Ultrasound is often performed along with nerve and tendon exercises. Ultrasound treatment appears to be effective in the short term, but its long-term benefit remains unknown.
Yoga and Other Exercise Programs
Very limited evidence suggests that yoga practice may provide some benefit for patients with carpal tunnel syndrome. Yoga postures are designed to stretch, strengthen, and balance upper body joints.
General Exercise Program
Some experts have reported that people who are physically fit, including athletes, joggers, and swimmers, have a lower risk for cumulative trauma disorders. Although there is no evidence that exercise can directly improve CTS, a regular exercise regimen using a combination of aerobic and resistance training techniques strengthens the muscles in the shoulders, arms, and back; helps reduce weight; and improves overall health and well-being.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs (NSAIDs), which include aspirin and ibuprofen (Advil), are the most common pain relievers used for CTS. They block prostaglandins, the substances that dilate blood vessels and cause inflammation and pain. However, there are few well-conducted studies to determine their role in CTS. To date, there is no evidence that they offer any long-term relief, and regular use can have serious side effects. Therefore, NSAIDs are generally not used for the long-term treatment of carpal tunnel symptoms.
Other Conservative Approaches
Ice may help with acute pain. Some patients have reported that alternating warm and cold soaks is beneficial. (If hot applications relieve pain, most likely the problem is not caused by CTS but by another condition that produces similar symptoms.)
Low-Level Laser Therapy
Some investigators are working with low-level laser therapy (LLLT), which generates extremely pure light in a single wavelength. The procedure is painless. However, 2 trials comparing laser therapy to conservative treatment or a placebo laser treatment found no real benefit from this therapy.