I’m writing this article for people who want to avoid carpal tunnel surgery. Yes, I am a hand surgeon but I’m also a physician, and part of our jobs as physicians is to educate patients about prevention of disease. Hopefully I can teach people about ways to reduce the risk of carpal tunnel syndrome (CTS) and provide options for treatment prior to requiring surgery.
As a disclaimer, patients who have severe carpal tunnel syndrome should be evaluated promptly and not delay treatment unnecessarily. Constant numbness in the hand and loss of muscle mass at the base of the thumb are signs of nerve damage and severe CTS. Surgery is the best way to prevent the nerve from being damaged irreversibly. If people wait too long before having surgery, some of the hand numbness can be permanent.
Also, not all hand pain, numbness, and tingling are caused by CTS. If your symptoms are progressive, severe, or not responding to treatment, get an evaluation by a hand specialist or primary care physician sooner rather than later. The recommendations below are intended for patients with mild to moderate CTS symptoms, or in people who want to prevent the symptoms from occurring in the first place. There are some things we can’t change about our health, such as our family history, age and anatomy, but there are many things which we can modify.
Helpful things to do other than surgery for carpal tunnel syndrome:
Treatments which are NOT helpful for CTS:
Here is some background information about the carpal tunnel anatomy, which will help you understand what is going on. The nerve which supplies most of the sensation to the hand is called the median nerve. The median nerve allows you to feel the thumb, index finger, middle finger, and a portion of the ring finger. This nerve travels through the carpal tunnel in the palm side of the wrist. The carpal tunnel is a narrow, oval-shaped space, and it is made up of the carpal bones of the wrist and strong ligaments in the palm. The tendons which move the thumb and fingers also travel through the carpal tunnel. Each finger has 2 tendons and the thumb has one tendon. In total, 9 tendons and the median nerve are within the carpal tunnel. In addition to supplying most of the sensation of the hand, the median nerve also controls the thenar muscles at the base of the thumb.
The carpal tunnel is naturally a tight space, and the median nerve is at risk for compression in this location. Nerves are delicate and they do not like to be compressed. Patients often experience hand numbness, tingling, pins and needles, electric shocks, and weakness when a nerve is pinched. The feeling in the pinky finger is supplied by a different nerve, and that is why this finger is usually not numb in patients with CTS. Symptoms are often worse at night. In addition, the pain can radiate up the arm, waking the patient up from sleep.
Most people, including myself, sleep with the wrist bent. When the wrist is not kept straight, the pressure within the carpal tunnel increases. Therefore, when the wrist is bent for a long period of time, such as during sleep, the nerve is compressed. This can cause symptoms at night. The simplest treatment is to use an over-the-counter wrist brace to keep the wrist straight and train yourself not to keep the wrist bent during sleep. Otherwise you’ll wake up with the hand numb/tingly and have to reposition your arm and shake out the numbness to get the feeling back.
A physical therapist, occupational therapist, or certified hand therapist can teach you exercises which you can learn to do on your own. Nerve and tendon gliding exercises have been shown to be helpful in carpal tunnel syndrome. Simple exercises I have found helpful are stretches which involve the fingers and wrist, pulling them back into extension and holding the stretch for 20 seconds, then relaxing. This can be repeated for up to 5 minutes per session, 2-3 times per day. This stretch shouldn’t be painful or done with excessive force. Therapists can also do therapeutic ultrasound and iontophoresis treatments which can help reduce symptoms.
Several studies have shown a reduction in carpal tunnel symptoms when patients were involved in an exercise program, particularly vigorous physical activity. Jogging, swimming, playing sports, biking, even walking around the neighborhood are all physical activities which are good for you, and your carpal tunnel!
Obesity or high body mass index (BMI) has been shown to be a strong risk factor for carpal tunnel syndrome. Weight loss might reduce this risk. Weight loss is not always easy, so working with a nutritionist and/or exercise coach may help.
Nicotine is an addictive chemical in tobacco products. It also constricts arteries and reduces blood flow in the body. If the blood flow in the hand is reduced, the nerves can be more sensitive to injury. Stopping tobacco use may reduce the risk of CTS symptoms and is good for your overall health. Consider talking to your primary care physician about quitting.
Pressure on the nerve within the carpal tunnel is increased with forceful gripping tasks. It would make sense to take rest breaks and do stretches when you need to use the hands for heavy gripping. For example, when I am in heavy traffic and “white knuckle” gripping the steering wheel, my hands will go numb. A lighter grip on the wheel will help this calm down. Using vibrating power tools in the yard, such as a hedge trimmer or edger, can also flare up CTS symptoms. Gardening has also been shown in studies to contribute to CTS symptoms. Motorcycle riders often get CTS symptoms because they are forcibly gripping the handlebars and getting hand vibration from the ride. Common sense tells us to be careful with these activities and adjust how the hand is used when possible.
Whether or not computer work increases the risk of carpal tunnel syndrome is controversial. Some studies suggest that prolonged computer work can contribute to carpal tunnel syndrome, other studies do not show this risk. I suspect that it is not the computer itself that is the culprit, but the way we use it. If someone has poor posture at their desk and types with the wrists bent for a prolonged period of time, there can be increased pressure on the nerves. I would suggest taking rest breaks, stretching, and maintaining good posture of the neck, back, shoulders and wrists to avoid CTS symptoms.
Corticosteroid injections are commonly used in the office of orthopedists and hand specialists. These are often called “cortisone shots.” Corticosteroids are steroid hormones produced in the body. They have many different biologic functions, one of which is regulation of inflammation. If used carefully and sparingly, steroid injections are safe and have few side effects. Having steroids injected into the same location multiple times can cause problems, and this is not usually recommended.
Most patients obtain at least temporary relief from CTS symptoms from a steroid injection. Symptom relief is about 3 months or so on average. In some studies, approximately 1/3 of patients can have long-term resolution of symptoms from a single injection, and these patients do not require surgery. I think it is reasonable to try a steroid injection in patients with mild to moderate CTS prior to considering surgery. Steroid injections will not cure carpal tunnel syndrome in severe CTS cases.
Non-steroidal anti-inflammatory drugs (NSAIDs) are oral medications used to reduce pain and inflammation. Examples are ibuprofen and naproxen, which can be purchased over-the-counter. Some patients can have short-term relief of CTS symptoms with these medications. However, most research studies do not recommend using NSAIDs for CTS treatment, especially long-term. Use of NSAIDs is associated with increased risk of gastrointestinal bleeding, kidney disease, and heart attack. These risks increase in patients with certain medical problems and when used long-term or at higher doses.
Finally, beware of cure-all treatments you may find online. If something sounds too good to be true, it probably is. And if someone is trying to sell you something with a money-back guarantee and 100% successful results, think twice before buying.
If you need carpal tunnel surgery, don’t be afraid to consult with a hand specialist who is an expert in treatment of CTS.
Dr. John M. Erickson is a hand and upper extremity specialist at the Raleigh Hand Center. He trained in orthopedic surgery at the University of Michigan and completed a hand surgery fellowship at Vanderbilt University. He is an active member of the American Society for Surgery of the Hand (ASSH).