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Carpal tunnel syndrome - Treatment, Complications, Prognosis


Prevention

What is the treatment for carpal tunnel syndrome?
It’s important to treat carpal tunnel syndrome as early as possible after symptoms start. The choice of treatment for carpal tunnel syndrome depends on the severity of the symptoms and any underlying disease that might be causing the symptoms.
Initial treatment usually includes rest, immobilization of the wrist in a splint, and occasionally ice application.
The various treatments for CTS are outlined below.

Nonsurgical treatments
If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel syndrome, including:
Wrist splinting.
A splint that holds your wrist still while you sleep can help relieve night time symptoms of tingling and numbness. Night time splinting may be a good option if you're pregnant.
Nonsteroidal anti-inflammatory drugs (NSAIDs).
NSAIDs, such as ibuprofen (Advil, Motrin IB, others), may help relieve pain from carpal tunnel syndrome in the short term.
Corticosteroids.
Your doctor may inject your carpal tunnel with a corticosteroid such as cortisone to relieve pain. Sometimes your doctor uses an ultrasound to guide these injections.
Corticosteroids decrease inflammation and swelling, which relieves pressure on the median nerve. Oral corticosteroids aren't considered as effective as corticosteroid injections for treating carpal tunnel syndrome.
If carpal tunnel syndrome is caused by rheumatoid arthritis or another inflammatory arthritis, then treating the arthritis may reduce symptoms of carpal tunnel syndrome. However, this is unproved.

Surgical treatments
Surgery may be appropriate if your symptoms are severe or don't respond to other treatments.
The goal of carpal tunnel surgery is to relieve pressure by cutting the ligament pressing on the median nerve.
The surgery may be performed with two different techniques:
Endoscopic surgery.
Your surgeon uses a telescope-like device with a tiny camera attached to it (endoscope) to see inside your carpal tunnel. Your surgeon cuts the ligament through one or two small incisions in your hand or wrist. Endoscopic surgery may result in less pain than does open surgery in the first few days or weeks after surgery.
Open surgery.
 Your surgeon makes an incision in the palm of your hand over the carpal tunnel and cuts through the ligament to free the nerve.
Discuss the risks and benefits of each technique with your surgeon before surgery.
During the healing process after the surgery, the ligament tissues gradually grow back together while allowing more room for the nerve. This internal healing process typically takes several months, but the skin heals in a few weeks.

Alternative medicine
Integrate alternative therapies into your treatment plan to help you cope with carpal tunnel syndrome. You may have to experiment to find a treatment that works for you. Always check with your doctor before trying any complementary or alternative treatment.
Yoga. Yoga postures designed for strengthening, stretching and balancing the upper body and joints may help reduce pain and improve grip strength.
Hand therapy. Early research suggests that certain physical and occupational hand therapy techniques may reduce symptoms of carpal tunnel syndrome.
Ultrasound therapy. High-intensity ultrasound can be used to raise the temperature of a targeted area of body tissue to reduce pain and promote healing. Research shows inconsistent results with this therapy, but a course of ultrasound therapy over several weeks may help reduce symptoms.

Complications
Complications of carpal tunnel syndrome are uncommon but include atrophy and weakness of the muscles at the base of the thumb in the palm of the hand. This can be a permanent complication if not corrected early enough. This can lead to lack of dexterity of the affected fingers.

Outlook
The outlook is generally excellent as carpal tunnel syndrome usually responds to the conservative measures reviewed above. Sometimes surgical operation is necessary, and residual weakness can occur.




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