Techniques to Control CTS

Carpal tunnel syndrome (CTS) is a condition that occurs when the median nerve is compressed under the transverse carpal ligament in the wrist. CTS is characterized by pain in the palm which frequently extends to the thumb, index finger, middle finger and half of the ring finger (on the thumb side). Numbness and tingling can also occur in these areas. In severe cases weakness can develop. There are several ways to treat CTS.

Activity Modification

• The best way to decrease symptoms associated with CTS is to identify the activities that are causing it. CTS develops with repetitive gripping, use of power tools and other items that require gripping for sustained periods of time, use of tools that vibrate and repetitive finger flexion activities like typing. Frequent rest breaks and alternating activities every hour will help decrease symptoms. Padded gloves can be used with power tools and vibrating tools to provide shock absorption. In addition, watches and other tight jewelry that can increase pressure around the wrist should be avoided.

Splinting

• Wrist position influences pressure on the median nerve. Tension on the median nerve increases when the wrist is bent forward, and in some people it increases when the wrist is bent backward as well. Splints are available over-the-counter to keep your wrist in a neutral position. These splints cross the hand and wrist, have a thumb hole and Velcro straps to keep it in place. When you obtain a splint, remove the metal bar, place it on the floor and step on it to remove the bend. This will put the splint in a neutral position. The splint should be worn during any activity that increases symptoms and when sleeping at night.

Drugs

• Over-the-counter and prescription medications are used to treat CTS. Nonsteroidal anti-inflammatory drugs help to decrease pressure in the carpal tunnel, which can decrease pain. Doctors may prescribe a course of steroid medication to decrease inflammation as well. In more advanced cases, cortisone can be injected directly into the carpal tunnel.

Physical Therapy

• Physical therapy is often prescribed to treat CTS. Modalities like ultrasound, low level cold laser, massage, stretching and strengthening help to decrease pain and inflammation, lengthen tight muscles and improve functional abilities affected by weakness. In addition, a physical therapist can provide specific information about activity modification to prevent symptoms from recurring.

Surgery

• In some cases CTS does not resolve with conservative treatment. Surgery is performed to relieve pressure in the carpal tunnel by cutting through the transverse carpal ligament. This is typically performed endoscopically which requires minimal incisions. Scar tissue might need to be removed around the median nerve which requires an open surgical procedure to be performed.