What are the treatment options?
Try not to over-use your wrist by excessive squeezing, gripping, wringing, etc. If you are overweight, losing some weight may help. Painkillers may be prescribed to ease the pain. If the condition is part of a more general medical condition (such as arthritis) then treatment of that condition may help.
Not treating may be an option
In about 2 in 3 cases that develop during pregnancy, the symptoms go after the baby is born. So, not treating is an option, particularly if symptoms are mild. The situation can be reviewed if symptoms get worse.
A wrist splint
A removable wrist splint (brace) is often advised as a first active treatment. The aim of the splint is to keep the wrist at a neutral angle without applying any force over the carpal tunnel so as to rest the nerve. This may cure the problem if used for a few weeks. However, it is common to wear a splint just at night, which is often sufficient to ease symptoms.
A steroid injection
An injection of steroid into, or near to, the carpal tunnel is an option. One research trial found that a single steroid injection eased symptoms in about 3 in 4 cases. In this trial the symptoms returned in some people over the following year. Other studies report variable success rates with steroid injections.
Surgery is recommended for severe cases but the jury is still out as to whether it is better than injections for moderate symptoms. A large trial is being conducted to answer this question.
A small operation can cut the ligament over the front of the wrist and ease the pressure in the carpal tunnel to give your nerve more space. This usually cures the problem. It is usually done under local anaesthetic. There are two main types of surgery - open and keyhole. Your surgeon will discuss which technique is appropriate for you.
You will not be able to use your hand for work for a few weeks after the operation. A small scar on the front of the wrist will remain. There is a small risk of complications from surgery. For example, following surgery there is a very small risk of infection and damage to the nerve or blood vessels. Sometimes, the nerve can get caught up in the scar and become stretched when the wrist is moved: this is known as tethering.
Over the years, a wide range of other treatments has been advocated. For example, controlled cold therapy, ice therapy, laser therapy and exercises. None of these treatments has good research evidence to support its use and so they are not commonly advised. However, they can work for some people. There is some evidence that acupuncture may work for some people.
Steroid tablets may ease symptoms in some cases. However, there is a risk of serious side-effects from taking a long course of steroid tablets. Also, a local injection of a steroid (described above) probably works better. Therefore, steroid tablets are not usually advised.
Which is the best treatment for me?
A non-surgical option may be advised if your symptoms are mild - for example, if your symptoms come and go and mainly consist of tingling, pins and needles or mild discomfort. A wrist splint (brace) may work but a steroid injection is probably the most effective non-surgical treatment.
If you try a non-surgical treatment and it does not work, do return to your doctor. In particular, see your doctor if you have constant numbness in any part of your hand, or if you have any weakness of the muscles next to the thumb. These symptoms mean that the nerve is not working well and is at risk of permanent damage.
Surgery gives the best chance of long-term cure. It is quite a common operation. It is done if symptoms continue (persist) despite other treatments, or if symptoms are severe and the nerve is in danger of permanent damage.
Treatment for severe symptoms
If you have severe symptoms - in particular wasting of the muscles at the base of the thumb - then you will probably need surgery. This is to relieve pressure on (decompress) the trapped nerve quickly, which aims to prevent any permanent long-term nerve damage.
Carpal tunnel syndrome during pregnancy
Symptoms commonly go after the baby is born. Therefore, a non-surgical treatment, such as a splint, is usually advised at first. Surgery is an option if symptoms persist.
Further reading and references
Vasiliadis HS, Georgoulas P, Shrier I, et al; Endoscopic release for carpal tunnel syndrome. Cochrane Database Syst Rev. 2014 Jan 311:CD008265. doi: 10.1002/14651858.CD008265.pub2.
Ghasemi-Rad M, Nosair E, Vegh A, et al; A handy review of carpal tunnel syndrome: From anatomy to diagnosis and treatment. World J Radiol. 2014 Jun 286(6):284-300. doi: 10.4329/wjr.v6.i6.284.
Carpal tunnel syndrome; NICE CKS, September 2016 (UK access only)
Mason W, Ryan D, Khan A, et al; Injection versus Decompression for Carpal Tunnel Syndrome-Pilot trial (INDICATE-P)-protocol for a randomised feasibility study. Pilot Feasibility Stud. 2017 Apr 243:20. doi: 10.1186/s40814-017-0134-y. eCollection 2017.
Lyon C, Syfert J, Nashelsky J; Clinical Inquiry: Do corticosteroid injections improve carpal tunnel syndrome symptoms? J Fam Pract. 2016 Feb65(2):125-8.
I have a 'non typical' carpal tunnel injury, caused by extreme vibration when holding wood in my hand and cutting it with an electric saw. I have been advised to wear a CT brace for '4 weeks or so'...Rocketman SG6UK
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