Treatment

Treatment is aimed at relieving the symptoms of carpal tunnel syndrome by reducing pressure on the median nerve, often by a simple operation.

Underlying conditions such as rheumatoid arthritis and hypothyroidism should be treated first, and in any case, treatment should begin as early as possible.

Self–Help

Individuals often claim to achieve temporary relief of symptoms by hanging their arm out of bed during the night or by vigorously shaking the wrist using a flicking action. Such relief is of short duration.

Mild symptoms may be relieved by the application of ice packs to the wrist and by resting the hand and wrists.

If the condition is linked to the use of the hand, it is important to avoid the repetitive movements that cause symptoms.

Stretching and strengthening exercises may help relieve symptoms and maintain mobility of the wrist and arm. Some people find benefit from acupuncture or chiropractic but their effectiveness remains unproven.

Assistive Equipment

Prescribed wrist splints which extend the wrist at an angle of 10-15 degrees ease symptoms by avoiding more pressure on the compressed nerve.

Medicine

Non–steroidal anti–inflammatory drugs (NSAIDs) such as Ibuprofen or Diclofenac can reduce swelling and thus relieve pain, but there is little evidence to support their effectiveness for carpal tunnel syndrome.

Steroid injections administered into the carpal tunnel reduce swelling and provide temporary relief.

Diuretics (water tablets) may relieve symptoms if excess fluid in the body is thought to be causing the swelling. However, there is little scientific evidence to support their effectiveness in carpal tunnel syndrome.

Surgery

If the condition is getting worse and symptoms have been present for about 6 months, surgery may be indicated. This is the only effective long–term treatment for carpal tunnel syndrome.

The operation is called ‘carpal tunnel release’ and it involves cutting the carpal ligament and so ‘taking the roof off the tunnel’ so as to make more space for the median nerve and tendons. This can often be performed as a day case, and may be done by using an endoscope (a small flexible telescope), or by the more traditional method of open operation.

Although symptoms may be relieved immediately following surgery, full recovery may take a few months.

Very rarely some patients may develop infection, nerve damage, stiffness and pain from the scar following surgery. Occasionally the wrist loses strength because the carpal ligament has been severed. These complications are, however, uncommon.

Some people may need to change their duties at work or even change jobs completely following surgery.

Recurrence of carpal tunnel syndrome following surgery is uncommon. Most individuals recover swiftly and completely; a return to unrestricted work activity is to be expected in the majority of cases.