Carpal Tunnel Syndrome

Treatment

At Mayo Clinic, the medical team determines treatments based on:

• the severity of the condition
• history of previous treatments for the condition
• overall health and the demands of occupation/daily activities
• the patient's preference

View animation of minimally invasive carpal tunnel surgery.

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In the earliest stages, the numbness and tingling can be relieved simply by shaking the hand, which eases the pressure on the median nerve. If symptoms persist and worsen, getting rid of the numbness and tingling becomes increasingly difficult.

Waking up in the night with numbness and tingling is common, since sleep positions often hyperextend or hyperflex the wrist, pinching the median nerve.

Special physical therapy exercises, heat treatments and massage may alleviate some discomfort, along with avoiding the movements or strain on the wrist that provoke the symptoms.

If symptoms persist, more aggressive treatments are available. Most patients, but not all, improve following treatment.

Four treatment strategies are used, depending on the severity of the condition: A splint or brace; nonsteroidal, anti-inflammatory drugs; cortisone injections; and surgery (open incision or endoscopic).

Splint or Brace

In the early stages of CTS, a night splint is the first treatment recommended. This splint keeps the wrist in a neutral position (not bent back too far nor down too far) during sleep, minimizing pressure on the median nerve and relieving the nighttime symptoms of tingling and numbness. The splint can also be effectively used during the day. Using a splint can make CTS symptoms disappear in some patients.

Nonsteroidal Anti-inflammatory Drugs

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDS) may help relieve pain caused by swelling of the carpal tendons. They may be most effective when used in combination with other nonsurgical treatments; which makes it difficult to know how much the NSAIDS are adding to the known benefits of the other treatments.

If inflammation is not the cause of a patient's pain, NSAIDS are unlikely to help. They also won't help with other symptoms such as tingling, numbness or weakness. The potential side effects of taking NSAIDS over a long period of time must also be weighed.

Cortisone Injections

Injecting the affected area with a steroid drug such as cortisone may provide some relief from symptoms. This treatment may be useful in pregnancy-related carpal tunnel syndrome or in cases where using a splint and nonsteroidal, anti-inflammatory drugs have failed to relieve the symptoms. Relief can last up to six months and sometimes longer. If symptoms recur, injections can be repeated, but not more than once every six weeks.

The injected steroid drug spreads around the swollen membranes and surrounding tendons and shrinks them, relieving the pressure on the median nerve. The cortisone amount is small and when used this way, usually has no harmful side effects.

Iontophresis is a newer way to get cortisone medications into the carpal tunnel. An electrical current is used to move the molecules of the medication through the skin into the carpal tunnel. The technique is less painful than an injection, but may not be as effective in some people.

Surgery (Open Incision or Endoscopic)

Carpal tunnel surgery "releases" pressure on median nerve.

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Surgery to relieve CTS is called carpal tunnel release. It involves cutting the ligament that forms the roof of the carpal tunnel to relieve the pressure on the median nerve. It may be performed as an endoscopic or as an open procedure. At Mayo Clinic this operation is performed by surgeons with special training in hand surgery. Surgeons in orthopedic surgery, plastic surgery and neurosurgery may be involved.

Endoscopic (Minimally Invasive) Surgery

At times, surgery can be done with an endoscope, a device with a tiny television camera attached to it that allows the surgeon to see inside the carpal tunnel and perform the surgery through small incisions in the hand or wrist. The endoscopic method is more technically demanding and it is important to select a medical center experienced in this technique.

Open Incision

In open surgery, the surgeon makes an incision in the wrist over the carpal tunnel and releases the nerve.

At Mayo Clinic, open and endoscopic procedures are done under local anesthesia, and patients usually go home soon after surgery. In most cases, surgery results in significant improvement in symptoms, but some residual numbness, pain or weakness may persist.

Following Surgery

Following surgery, most surgeons permit light use of the hand and wrist within a few days. Unrestricted use may take from several weeks to as long as a few months.

If surgery appears to be the best alternative for relieving symptoms or preventing further muscle atrophy, the patient and surgeon should discuss the procedure that will work best.