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There has been much discussion as to the most effective treatment for CTS. However, treatments can be generally divided into six basic categories:
Reversible causes
Some causes of CTS are secondary to other conditions — metabolic disorders such as hypothyroidism, for example. Treatment of the primary disorder often resolves CTS symptoms.
Immobilizing braces
The importance of wrist braces and splints in the carpal tunnel syndrome therapy is known for many people, but many people are unwilling to use it. In 1993, The American Academy of Neurology recommend a non-invasive treatment for the CTS at the beginning (except for sensitive or motor deficit or grave report at EMG/ENG): a therapy using splints was indicated for light and moderate pathology.[20] Current recommendations generally don't suggest immobilizing braces, but instead activity modification and non-steroidal anti-inflammatory drugs as initial therapy, followed by more aggressive options or specialst referral if symptoms do not improve.
Many health professionals suggest that, for best results, one should wear braces at night and, if possible, during the activity primarily causing stress on the wrists. Healing braces can sometimes exacerbate the cause of wrist pain and misalignment by continuing to prohibit proper functionality of the wrist.
Physiotherapy
Physiotherapy offers several ways to treat and control carpal tunnel syndrome. This procedure should be directed specifically towards the pattern of pain / symptoms and dysfunction assessed by the therapist. As such, it may include a range of modalities ranging from soft tissue massage, conservative stretches and exercises, splints, and techniques to directly mobilise the nerve tissue.
Clinically, sometimes a patient will present with a hand that is very inflamed and swollen with severe symptoms of pain, tingling and numbness and almost a fear of use due to the pain. In these cases a physiotherapist may focus on techniques to reduce the pain and inflammation, and exercises to encourage improved circulation. A comprehensive review of effectiveness of hand therapies in carpal tunnel management demonstrates that there is some valid scientific evidence for a range of therapeutic modalities.
Body Awareness Therapy such as the Feldenkrais method has been studied in relation to fibromyalgia and chronic pain and studies have indicated positive effects. Structured exercise programs using these therapies to reduce wrist pain have been developed.
CTS is a multi-faceted problem and can be challenging to treat from a clinicians perspective. Starting therapy early when carpal tunnel is in a mild stage is associated with improved long-term results.
Localized steroid injections
Steroid injections can be quite effective for temporary relief from symptoms of CTS for a short time frame while a patient develops a longterm strategy that fits with his/her lifestyle. In certain patients an injection may also be of diagnostic value. This treatment is not appropriate for extended periods, however. In general, medical professionals only prescribe to localized steroid injections until other treatment options can be identified. For most patients, permanent relief requires surgery.
Prioritizing hand activities and ergonomics
Any forceful and repetitive use of the hands and wrists can cause upper extremity pain. More frequent rest can be useful if it can be orchestrated into one's schedule. It has been shown that taking multiple mini breaks during the stressful activity is more effective than taking occasional long breaks. There are computer applications that aid users in taking breaks. All of these applications have recommended defaults, following the most effective average break configuration, which is a 30 sec. pause every 3 to 5 minutes (the more severe the pain, the more often one should take this break). Before investing in these types of programs, it's best to consult with a doctor and research whether computer use is causing or contributing to the symptoms, as well as getting a formal diagnosis.
More pro-active ways to reducing the stress on the wrists which will alleviate wrist pain and strain involve adopting a more ergonomic work and life environment. Switching from a QWERTY computer keyboard layout to the Dvorak Simplified Keyboard layout was commonly cited as beneficial in early CTS studies, however meta-analyses of these studies report significant flaws in the research and question the usefulness of such keyboards.
It is also important that one's body be aligned properly with the keyboard. This is most easily accomplished by bending ones elbows to a 90 degree angle and making sure the keyboard is at the same height as the elbows. Also it is important not to put physical stress on the wrists by hanging the wrist on the edge of a desk, or exposing the wrists to strong vibrations (e.g. manual lawn mowing). Position the computer monitor directly in front of your seat, so the neck is not twisted to either side when viewing the screen.
Exercises that relax and strengthen the muscles of the upper back can reduce the risk of a double crush of the median nerve. Spinal manipulations performed by an osteopath, physical therapist or chiropractor may be appropriate to relieve compression of the nerve.
Medication
Using an over-the-counter anti-inflammatory such as aspirin, ibuprofen or Naproxen can be effective as well for controlling symptoms. Pain relievers like Tylenol will only mask the pain, and only an anti-inflammatory will affect inflammation. Non-steroidal inflammatory medications theoretically can treat the root swelling and thus the source of the problem. Oral steroids (prednisone) do the same, but are generally not used for this purpose due to significant side effects. The most common complications associated with long-term use of anti-inflammatory medications are gastrointestinal irritation and bleeding. Also, some anti-inflammatory medication have been linked to heart complications. Use of anti-inflammatory medication for chronic, long-term pain should be done with doctor supervision.
A more aggressive pharmaceutical option is an injection of cortisone, to reduce swelling and nerve pressure within the carpal tunnel.
Mecobalamin/Methylcobalamin has been helpful in some cases of CTS.
Carpal tunnel release surgery
When visiting a hand surgeon, the first step would be examination of the hands and a review of the symptoms. If CTS is suspected, depending on the severity and the situation, the surgeon may first prescribe non-operative treatment with splinting and anti-inflammatory drugs. Nerve conduction tests will positively determine the level of compression, if any.
If symptoms resolve with non-surgical interventions, surgery can frequently be avoided. If not, then the "carpal tunnel release" surgery is recommended. In general, milder cases can be controlled for months to years, but severe cases are unrelenting symptomatically and likely will come to surgical treatment.
There are several carpal tunnel release surgery variations: each surgeon has differences of preference based on their personal beliefs and experience. All techniques have several things in common, involving brief outpatient procedures; palm or wrist incision(s); and cutting of the transverse carpal ligament.
All of the surgical options typically have relatively rapid recovery profiles (days to weeks depending on the activity and technique), and all usually leave a cosmetically insignificant scar.
The two major types of surgery are open-hand surgery and endoscopic surgery. Most surgeons perform open surgery, widely considered to be the gold standard. However, many surgeons are now performing endoscopic techniques. Open surgery involves a small incision somewhere on the palm about an inch or two in length. Through this the ligament can be directly viewed and divided with relative safety. Endoscopic techniques involve one or two smaller incisions (less than half inch each) through which instrumentation is introduced including probes, knives and the scope to see what you are doing. The ligament is viewed through a "keyhole" in this way and can be divided with relative safety.
Surgery to correct carpal tunnel syndrome has a 90% or higher success rate, especially using endoscopic surgery techniques. In general, endoscopic techniques are as effective as traditional open carpal surgeries, though the faster recovery time typically noted in endoscopic procedures may be offset by higher complication rates. Success is greatest in patients with the most typical symptoms. The most common cause of failure is incorrect diagnosis, and it should be noted that this surgery will only fix carpal tunnel syndrome, and will not relieve symptoms with alternate causes. Recurrence is rare, and apparent recurrence usually results from a misdiagnosis of another problem. Complications can occur, but serious ones are infrequent to rare.
Carpal tunnel surgery is usually performed by an orthopaedic or plastic surgeon; some neurosurgeons and general surgeons also perform the procedure.
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Important notice:
The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other
qualified health provider with any questions you may have regarding a medical condition.
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