Treatment of Carpal Tunnel Syndrome

Treatment

Treatment for carpal tunnel syndrome is broadly divided into conservative (non-surgical) methods and surgical methods. In general, conservative treatment may be possible when the symptoms are not severe, there is no thenar muscle atrophy, and it has not been long since the symptoms began. Surgical treatment should be considered when the thenar muscles have atrophied and become flattened, when a definite pathology requiring removal, such as a tumor within the carpal tunnel, is found, when there is no improvement or the condition worsens despite more than 3 months of conservative treatment, or when the condition recurs after surgical treatment. Therefore, it is advisable to decide on a specific treatment method after discussing the advantages and disadvantages of each treatment option thoroughly with a doctor.

1. Non-surgical (conservative) treatment methods

1. Rest

Having numbness in the hand does not necessarily mean that surgery is required. In early cases where hand numbness occurs only occasionally, symptoms may improve simply by avoiding positions in daily life that cause the wrist to bend. Reducing excessive use of the wrist and hand, and supporting the wrist with a cushion to prevent working for long periods with the wrist in a lowered position, may also improve symptoms. When using a computer, it is also helpful to use a wrist rest cushion when using the mouse or keyboard.

2. Wrist splint

Temporarily immobilizing the wrist with a splint without medication can also relieve the symptoms of carpal tunnel syndrome by preventing overuse of the wrist. If pain during sleep is the main problem, wearing a splint while sleeping can improve symptoms. This helps prevent the wrist from being bent or extended too much during sleep.

3. Oral medication treatment

Helpful medications include anti-inflammatory analgesics and vitamin B, which promotes nerve regeneration. If there is inflammation (tenosynovitis, synovitis) around the tendons and the membrane surrounding those tendons within the carpal tunnel, oral administration of anti-inflammatory analgesics may improve the condition. Even when awake, if there is mild pain or if hand strength occasionally becomes weak, anti-inflammatory analgesics may be effective. If swelling within the carpal tunnel is thought to be the problem, diuretics may also be used carefully together with anti-inflammatory analgesics, but this should be discussed cautiously with a doctor.

4. Injection therapy

This treatment method can be tried only 2-3 times at intervals of several weeks (4-6 weeks). It should be performed only when there is no definite pathology within the carpal tunnel. For example, injection therapy is best avoided if there is another disease, such as a tumor like a ganglion cyst within the carpal tunnel or an infection. It may also be effective when pain is relatively severe but nerve conduction study results are not poor, or when the condition is temporary, such as when it occurs during pregnancy. However, it should be noted that in many cases the relief of symptoms is temporary and recurrence is common. If symptoms worsen or persist despite non-surgical treatment, surgery should be considered.

2. Surgical treatment methods

Surgical treatment for carpal tunnel syndrome involves cutting the transverse carpal ligament that compresses the median nerve. When performing surgical treatment, local anesthesia is generally used by injecting an anesthetic into the incision site at the wrist, so there is little burden from anesthesia-related complications, and there are no inconveniences such as those associated with general anesthesia or regional anesthesia, with no particular problems in recovery after surgery. In the past, surgery was performed through a large incision in the wrist, which could leave a large scar on the wrist and palm and sometimes cause pain. Recently, however, endoscopic or minimally invasive methods have been used, resulting in only a 2-3 cm scar and better cosmetic outcomes.

Recently, with endoscopic surgery, it has become possible to cut the transverse carpal ligament in this area using an endoscope. However, the disadvantages of endoscopic surgery are that equipment must be available, the procedure is technically difficult and complex, the operation takes longer, it is more expensive, and there is a risk of damage to surrounding tissues.

So far, we have explained the treatment of carpal tunnel syndrome.

In the next installment, we will look at cardiopulmonary resuscitation.

Source: Korea Disease Control and Prevention Agency National Health Information Portal