Dr. Jonathan Y. Lee, a leading Singapore Hand Surgery and Orthopedic upper limb Specialist, discusses Carpal Tunnel Syndrome, a common cause of pain and numbness of the hands and fingers.
What Non-Surgical Treatments are useful for Carpal Tunnel Syndrome?
The current conservative treatments for carpal tunnel syndrome include splints, non-steroidal anti-inflammatory medications, activity modification, pyridoxine, and local injection of corticosteroids. In addition, yoga, chiropractics, ultrasound and laser treatment have also been advocated but evidence for their effectiveness is still lacking.
1. Wrist Splinting (or brace)
Splinting is the most popular method among the conservative treatments of Carpal Tunnel Syndrome. Splinting the wrist immobilizes the wrist in a neutral position to maximize carpal tunnel volume and minimize pressure on the median nerve, and aims to avoid further damage from twisting or bending. It is especially important to wear this splint during sleep or with activities that aggravate symptoms. Rest the affected hand and wrist for at least two weeks.
2. Non-Steroidal Anti-inflammatory medications (NSAIDs)
NSAIDs relieve pain and inflammation of the tendons (tenosynovitis) that pass through the carpal tunnel at the wrist. This in turn helps to reduce the pressure within the carpal tunnel that compresses the median nerve, and alleviates symptoms.
NSAIDs are very useful as short-term therapy for 2 and 4 weeks and for controlling occasional flare-ups. Long-term results with NSAIDs have been poor and have potentially serious side effects such as gastric irritation and ulceration.
3. Vitamin B6 (Pyridoxine)
Vitamin B 6, given in conjunction with vitamins B 1 and B 12 , has a pain-killing effect that is due to inhibition of the body’s natural pain conduction system. Studies demonstrate that vitamin B 6 is effective in relieving the pain associated with CTS, and there is also evidence that B6 deficiency may cause CTS in some cases (Jurna I 1998; Holm G et al 2003). One study (Holm G et al 2003) recommended that 200 mg vitamin B 6 daily be included in treatments for CTS.
However, Vitamin B6 should be used with caution since high doses over the long term can cause damage to the central nervous system or neuropathy (damage to peripheral nerves).
4. Corticosteroid or Cortisone injections
When an initial course of non-surgical treatments (such as rest, splints, and anti-inflammatory medicines) is unsuccessful, injections of corticosteroids directly into the carpal tunnel may sometimes be recommended.
Corticosteroids are powerful anti-inflammatory medicines and may have side effects. Repeat or multiple injections with corticosteroids should be avoided, to avoid the complications associated with corticosteroid injections, including nerve damage and relapse.
5. Activity Modification
Avoiding activities that may worsen symptoms, especially those that require repetitive hand and wrist movements, and the use of vibrating tools. Take frequent breaks and perform stretches and warm-ups before activity. Ergonomic changes at work may also include adjusting your desk, chair, and keyboard so you are in the best possible position.
In the very early stages of the condition, or as a preventive measure, try these hand and wrist exercises that may reduce your symptoms. [Link to blog-post on CTS exercises]
6. Control underlying conditions.
Controlling any underlying conditions, such as diabetes, rheumatoid arthritis, or hypothyroidism, which may contribute to some extent in making your carpal tunnel syndrome symptoms worse.
When do I need to see a doctor for my Carpal Tunnel Syndrome?
The relative safety of conservative treatment options offer obviously benefits in using them for the initial management of early Carpal Tunnel Syndrome. However, one should also consider that except in these early or mild cases, conservative therapy generally offers only temporary symptom relief.
Delay in formal medical assessment and definitive surgical treatments could result in progressive damage to the median nerve. The purpose of surgery is to relieve pressure on the nerve and prevent the condition from progressing, preventing permanent damage to the nerve that can sometimes lead to thumb muscle weakness and permanent numbness of the fingers.
If your symptoms persist beyond a few weeks or are increasing in severity; if your hand and finger numbness lasts for hours at a time or regularly interrupts your sleep; or if you have severe symptoms like weakness of grip, frequently dropping objects or inability to distinguish between different coin sizes etc., do see your local hand surgeon soon.
Tags: conduction system, conservative treatments, dr jonathan, flare ups, hands and fingers, median nerve, neutral position, nsaids, pyridoxine, vitamin b 6