Carpal tunnel syndrome - Treatments

Steroids

If your symptoms are severe, a steroid injection into your carpal tunnel will probably make your hand, arm and wrist feel less painful and swollen.[1] The full name for these medicines is corticosteroids.

Steroid injections may work better than surgery in the short term. But the effects of steroid injections may not last as long as the effects of surgery.

Most of the studies into this treatment lasted only for three months or less.[1] In one study that lasted for a year, 94 percent of people said they had a big improvement in symptoms after the injection, but that had dropped to 70 percent after a year. About 75 percent of people who had surgery said they had a big improvement in symptoms after the operation, and that stayed the same for the whole year.[2]

Another study looked at having a second injection two weeks after the first. It found that two injections didn't work better than one.[3]

There is a small risk that your tendon might rupture or the nerve could be hit by mistake when steroids are injected into your carpal tunnel.[4] [5]

The steroid injection is often combined with a local anaesthetic, so the injection should be painless.

Some research has shown that taking steroid tablets may ease the pain and swelling in your hand, arm and wrist after a couple of weeks.[6] [7] [8] Doctors don't often use tablets to treat carpal tunnel syndrome because injections probably work better.[9] Also, there may be serious side effects if you take steroid tablets for a long time.[10]

Wrist splints

Your doctor may suggest that you wear a splint to keep your wrist from bending. This is often suggested as a first treatment. One study (a randomised controlled trial) found that wearing a splint at night improved symptoms after two weeks.[11] And the benefits continued for four weeks. But splints do not work as well as surgery.[12]

We don't know if wrist splints work better if they are worn all the time, during the day or just at night. You might find it easiest to wear your splints at night and only during the day when you're relaxing in front of the television.

You can buy wrist splints that support your wrist at a natural, slight angle. Or you can ask your doctor to have a splint custom-made to keep your wrist in a straight, neutral position. But there's not enough research to say what type of splint works best. One small study found no difference in symptoms between the two types of splints.[13] Another small study found that custom-made splints worked better.[14]

Some people feel pins and needles in their hand for a short while when they take off their splint.[11]

Nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are painkillers that also reduce inflammation. They include drugs like ibuprofen (which you can buy over the counter) and naproxen and diclofenac (which you can get only with a prescription). But there hasn't been enough research to say if an NSAID will make your hand hurt less. One summary of the research found these drugs probably won't work any better than a dummy treatment (a placebo) to treat your carpal tunnel syndrome.[6]

But you may find that taking an NSAID helps if you also have a lot of pain and swelling in your fingers caused by tendon problems (doctors call this tendonitis).

NSAIDs have side effects, including nausea and diarrhoea. Taking high doses of some NSAIDs every day for a long time can increase your risk of a heart attack or a stroke. This isn't likely to be a problem if you take NSAIDs for a short time to treat pain. But if you'd like to read more, see Warnings about side effects of NSAIDs.

Vitamin B-6 (pyridoxine)

Some people try taking a daily dose of vitamin B-6 (pyridoxine) to relieve their numbness, tingling and pain from carpal tunnel syndrome. You can buy this vitamin supplement from chemists or health food shops. But there hasn't been enough research to tell us if vitamin B-6 can really help.

Two small studies (randomised controlled trials) showed that taking vitamin B-6 for up to 12 weeks didn't work any better than taking a dummy treatment (placebo).[15] [16] But these studies weren't very good quality, so the results may not be reliable. The studies didn't mention if the people who took vitamin B-6 to treat their carpal tunnel syndrome had any side effects. We know that numbness, tingling and not being able to walk properly were common side effects in people who took part in studies of vitamin B-6 at higher doses (200 milligrams).[17] Doses up to 10 milligrams a day are considered safe.[11]

Exercises

There are exercises you can try that are meant to relieve the trapped nerve in your wrist. You stretch your fingers and wrist in different positions to see if doing this can release the pressure on your nerve. The exercises are known as nerve and tendon gliding exercises. But there hasn't been enough research to say if doing these exercises helps with carpal tunnel syndrome.

One small study (a randomised controlled trial) looked at people who did these exercises five times a day for four weeks.[17] They also wore a wrist splint during the day and night. The people who exercised their fingers and wrist had a stronger grip after eight weeks. But their other symptoms were just as severe as those of people who hadn't done any exercises.

We don't know if nerve and tendon gliding exercises could harm you, because the research doesn't tell us. But there may be a risk that some exercises could make your condition worse. It's important to discuss what exercises you should be doing with a physiotherapist or another health professional.[18]

Ultrasound

Physical therapists sometimes use ultrasound (heat from sound waves) to treat carpal tunnel syndrome. There hasn't been enough good research to say whether ultrasound can heal your wrist.[19]

One study (a randomised controlled trial) found that people who had ultrasound were more likely to get better or recover completely after six months.[20] But this study wasn't high quality. Another small study found that having ultrasound five times a week for two weeks didn't make any difference to people's symptoms.[21]

Acupuncture

Some people try acupuncture for carpal tunnel syndrome. But there hasn't been any good research to say whether it works or not.

Acupuncture is based on the belief that energy called qi (sounds like 'chee') travels around the body along special pathways called meridians. When this energy flow gets blocked, you feel pain and have health problems. Acupuncture uses sterile needles to unblock this energy.

Massage

Some people try massage therapy for carpal tunnel syndrome. But there hasn't been any good research to say whether or not it works.

Massage involves rubbing and stroking the skin and flesh over the affected area, to try to ease muscle tension.

Surgery

There's a good chance that having surgery to release the pressure on the nerve inside your carpal tunnel will cure your carpal tunnel syndrome. In studies, about 8 in 10 people said they were better three months after the operation. This compares with about 5 in 10 people who had wrist splints instead of an operation. After a year, about 9 in 10 people who had surgery said they were better. The improvement lasted for at least 18 months.[12]

Studies comparing steroid injections with an operation found people were more likely to have a big improvement three months later with injections. But after six months, the effects of the injections had worn off for some people. Surgery was as good as injections after six months.[2]

But all operations have some risks. You'll need to think about whether you want to have the operation straight away or whether you want to try other treatments first. Your doctor can help you make this decision.

Surgery involves cutting free your carpal ligament (band of tissue) from your median nerve. The operation is usually done under local anaesthetic (which numbs your arm and hand but doesn't send you to sleep). You should be able to go home the same day.

You can have open or keyhole surgery for this operation. In open surgery, the surgeon makes a cut in your wrist up to 5 centimetres (2 inches) long. With keyhole surgery, the surgeon makes a small hole in your wrist and puts in a tube called an endoscope. The surgeon uses a tiny camera and instruments on the end of the tube. We don't know if one of these operations works better than the other. A large summary of the research (called a systematic review) found no difference in symptoms after either operation.[22] But some studies show people who have keyhole surgery can go back to work and get back to normal sooner.[22] [23]

Sometimes doctors advise wearing a wrist splint after surgery. But research shows this probably won't speed up your recovery.[24] The splint may cause more temporary pain and make your scar tender. You should be able to return to work sooner if you don't wear a splint after your operation.

Many people complain of side effects after surgery, but most are mild and don't last long.[25]

• Keyhole surgery may cause more temporary nerve problems, such as numbness and tingling, but you might get more problems from your wound if you have open surgery.
• It's possible the pain from your scar or stiffness at the wrist may end up worse than your carpal tunnel syndrome. Your wrist may also lose strength because your carpal ligament is cut. But these serious side effects are rare.

There's not enough research to tell us whether you might get other problems from the surgery later on. We also don't know if your carpal tunnel syndrome might come back several years after surgery. If you need another operation, this might not be so successful and the risk of having problems because of it is greater.[18]

Additional surgery

Some of the tissue around your nerve can also be cut when you have surgery for carpal tunnel syndrome. This is to try to free up the nerve more than by just cutting the carpal ligament. Doctors call this procedure internal neurolysis. This procedure isn't done very often nowadays.

The research shows this extra surgery is unlikely to help. After a year, people who had this additional surgery had symptoms similar to those of people who had just the basic operation.[26] [27] The complications from both kinds of operations were similar.[28]

Diuretics

Some people get fluid retention (their body holds onto extra fluid) when they are pregnant or starting the menopause. This might cause or worsen carpal tunnel syndrome. Swelling around your carpal tunnel may put pressure on the nerve to your hand. So doctors sometimes advise trying a diuretic drug (water pill) to stop your body holding onto extra fluid.

But taking a diuretic drug probably won't improve your carpal tunnel syndrome. Two studies (randomised controlled trials) show people who took a diuretic for four weeks felt no better than those who took a dummy treatment (a placebo) or an anti-inflammatory painkiller.[29] [30]

Some people in the studies said they felt sick or had stomach pain when taking a diuretic, but the side effects weren't serious.