Last updated: 11/24/2009

Once diagnosed, the first line of treatment for carpal tunnel syndrome is usually conservative in nature. This means that surgery is reserved as a last resort. Initial treatment may include taking frequent rest breaks from aggravating activity (if...

the activity cannot be completely avoided), anti-inflammatory medication, physical therapy, and using a splint or brace to keep the wrist in a neutral position; the splint is usually worn at night. Activities that bring on the symptoms are eliminated, avoided, or altered in some way to change the stress on the nerve. Tests to rule out conditions such as hypothyroidism may be conducted. If the problem is work-related, an assessment of the work environment from an ergonomic standpoint will be important. Work positions and tools used may need to be modified or changed completely.

If symptoms persist after conservative treatment, the injection of a corticosteroidal medication may be the next line of treatment suggested. This is an anti-inflammatory medication, but because it is injected directly into the area affected, it has a greater impact than medication that is taken orally. If injections are being considered, it is important that the doctor have considerable skill and experience in administering these injections, with a thorough understanding of the anatomy of the wrist and hand. After the injection, a restriction on any wrist movement will be imposed for several days, usually followed by the wearing of a wrist splint for about one month. Finally, hand and wrist exercises to stretch the tendons as well as increase hand strength may be recommended. While the injection tends to give good short-term results, long-term results are less promising. When symptoms are not relieved by these more conservative measures, then surgery may be the next step. It is estimated that about one third of patients will not respond to conservative treatment and will require surgery.

Surgery may be performed in the more tradition fashion, or endoscopically. In traditional surgical treatment, an incision is made in the palm of the hand to openly expose the underlying structures. In endoscopic surgery, a smaller incision is made in the palm or wrist into which endoscopic instruments are inserted. In both techniques, entry into the carpal tunnel is made and the tissue called the transverse carpal ligament is cut, which stops the compression on the median nerve from continuing. Extreme caution is taken to avoid cutting additional anatomical structures or damaging the surrounding nerves. Early reports on endoscopic surgeries showed an earlier return to work and routine activities, but with a higher incidence of nerve and tendon injuries. However, in 2002, several studies were reported showing endoscopic surgery to be comparable or superior to open excision surgery, without a higher rate of complications.