“Carpal Tunnel Syndrome?”

Carpal tunnel in earlier stages responds to splinting and/or cortisone injections. It depends on the severity of the carpal tunnel, but it can often get bad enough to require surgery. The good news is that the results of carpal tunnel release should be nearly 100%. I tell my patients it is about the only operation for which I can give a "Midas Muffler guarantee."

You may choose steroid injections, medicines, stem cells, and therapy.

Not really. When the problem gets severe, the best treatment is surgical. A cortisone injection may help temporarily, but is not always indicated. Consult with your hand surgeon.

It is important to know your symptoms, for example are you constantly numb or is the numbness intermittent, do you have any motor weakness in your thumb or difficulty with opposition tasks, does your hand wake you from sleep? Have you had a nerve conduction / electromyograph study to determine severity of you carpal tunnel and confirm carpal tunnel . Assuming you have failed a night time splint, and assuming that you do not have any atrophy or constant numbness, one could consider a carpal tunnel steroid injection to give relief.

Early symptoms of CTS can be managed with use of wrist splinting at night
as needed to control symptoms of awaking with numbness and pain in the
morning. When that is not effective or daytime symptoms predominate,
surgery is the most common recommended treatment because it is a relatively
simple procedure with high success rates (permanent ) and low risk of
complications. Occasionally when circumstances are not optimal for
surgery an injection of corticosteroid into the carpal tunnel may control
symptoms, but this is almost universally just a temporary solution.

When symptoms are severe and/or electrodiagnostic tests indicate severe
nerve impairment I recommend urgent surgery. Failure to proceed to surgery
may lead to irreversible nerve damage.

In answering this question, I am making the assumption that you have seen a hand or plastic surgeon, have undergone a physical examination and have had a nerve conduction study. There are a number of conservative measures that can be taken if the symptoms are of recent onset, such as activity modification, splinting at night and steroid injections to the carpal tunnel. However, if the symptoms do not go away completely within a short period of time, i.e., two weeks, it is best to undergo a decompression of the carpal tunnel, as the longer the compression of the median nerve (the nerve in the carpal tunnel) persists, the greater the risk of permanent nerve injury.

In 2007, I authored a paper that was published in Plastic and Reconstructive Surgery that reviewed a total of 14,722 patients with carpal tunnel syndrome who were treated with the endoscopic technique, the largest retrospective series published to date. What I noted from the data collected from this series of patients, was the direct correlation of the duration of symptoms and the incidence of permanent nerve injury. Moreover, review of the data also showed that the incidence of complications was much lower for the endoscopic over the open technique.

I recommend the endoscopic technique of release over the open technique for the following reasons: 1) The recovery time is much quicker. Most people can return to a desk job within a week of the surgery. I have seen patients return to work even faster if they were self-employed or they thought that their job was in jeopardy even though that was not recommended. With the open technique, the recovery can be as long as six weeks; 2) The safety record of the endoscopic technique as detailed above; 3) The lower scar burden associated with the endoscopic technique. Only the transverse carpal ligament is divided in the endoscopic technique, whereas in the open technique every layer of tissue from the surface of the nerve to the skin is divided, resulting in obliteration of gliding mechanism between the various tissue layers as they are now tethered with scar; and 4) The procedure only takes a few minutes to perform in experienced hands.

To summarize, in the case that conservative measures fail to completely relieve your symptoms within a two week period, surgical decompression should not be delayed. Endoscopic carpal tunnel release is safe and has a shorter recovery period than the open approach.

Nighttime bracing and over the counter pain relievers are helpful. However
if symptoms persist despite these conservative treatment options, surgery
may be indicated. For pregnant women and individuals over the age of 80
years, a cortisone injection is a viable treatment option.

You can try having steroid injected into the carpal canal, but if the compression is severe, it should be surgically released so the blood supply to the nerve is adequate. You do not want to lose feeling in your fingers if the nerve is severely compressed.

Carpal tunnel surgery is used to take the pressure off the median nerve in the carpal tunnel. Outcome is dependent upon the severity of the compression both acute and chronic components as well as understanding that there, like any operation has minor and major risks as well as the potential benefits. Conservative treatment can involve , rest, activity modification, NDAIDs, and splinting as well as corticosteroid injections . These can lower the pressure in the carpal tunnel and improve symptoms as well as in mild or even moderate cases work to relieve the need for surgery. Medications such as nuerontin may suppress nerve pain buyt do nothing to the pressure either acute or chronic on the nerve. Chronic nerve changes may not be reversible even with uncomplicated carpal tunnel surgery but having a chronic case is not a reason to hold off surgery as even if complete relief and cessation of all symptoms such as tingling and muscle weakness is not acheivable, halting progression is often important and often in the chronic cases the neuropathic pain can be alleviated even if there is not full recovery.

So while non surgical alternatives exist, if they do not take care of all the symptoms be sure to talk to your surgeon about the potential impact of waiting if surgery has been recommend.

A cortisone injection is typically the next most effective option behind the actual surgery. Other than that, acupuncture, hand therapy and even chiropractic treatment or bracing can be helpful.