Carpal Tunnel Treatment

If you need carpal tunnel treatment — let the expert orthopedic hand and wrist surgeons at Hoag Orthopedic Institute help you return to your activities in comfort.

What Is Carpal Tunnel Syndrome?

Carpal tunnel syndrome, or median nerve compression, is an often painful condition of the hand and wrist that causes numbness, tingling, or weakness. It is caused by a pinched nerve or pressure on your median nerve, which runs from your shoulder all the way into your hand. Carpal tunnel can be caused by overuse or repetitive motions (like typing) and is more commonly seen in women than men by a ratio of 3:1. Swelling and a thickening of the surrounding tissues narrow the space the nerve must pass through. This narrowing restricts blood flow to the nerve area, causing numbness and radiating pain in the hand, wrist, and forearm. Over time, carpal tunnel can also affect your hand strength and ability to grasp things effectively with the affected hand. The pain and dysfunction can affect your ability to do daily activities.

Developing carpal tunnel syndrome becomes more likely as we age, peaking around 50 or 60 years of age. There is also a strong correlation with patients who have a higher body mass index (BMI). Other risk factors include diabetes, hyperthyroidism, rheumatoid arthritis, and pregnancy. Carpal tunnel treatment ranges from conservative measures, including rest and wearing wrist splints, to surgical options for carpal tunnel relief.

Symptoms of Carpal Tunnel

Carpal tunnel causes numbness and pain in the hand, wrist, and forearm. If you are experiencing some of the symptoms below, please contact one of the fellowship-trained, board-certified hand surgeons at Hoag Orthopedic Institute and schedule an appointment. Together, you will explore your carpal tunnel syndrome treatment options.

• Numbness and tingling in the hand (median nerve sensory distribution)
• Pain radiating in the hand, wrist, and up the arm
• Symptoms worsen with increased activity in the hand and wrist (causing increased pressure to the median nerve)
• Decreased fine motor skills in the hand and wrist (difficulty buttoning a shirt or opening a jar)
• Weakness in your hands, difficulty holding, gripping, or pinching things
• Pain worsens at night and during sleep
• Cold intolerance, dryness, and unusual textures in the fingers (radial digits), signifying disruption of the sympathetic fibers carried by the median nerve

Why does carpal tunnel pain worsen during sleep?

Carpal tunnel relief is particularly critical at night, when the pain can impair your sleep. The symptoms worsen in sleep because:

• During sleep, we often flex our wrists, which increases pressure on the median nerve.
• Blood pressure decreases during sleep, causing poorer circulation to and from the nerve.
• Due to the inactivity during sleep, we are no longer “pumping” synovial fluid (an essential “lubricant”) out of the wrist.

Diagnosing Carpal Tunnel

When you come to Hoag Orthopedic Institute (HOI) for a physical exam, your hand doctor will consider many factors before diagnosing carpal tunnel, including how your symptoms developed.

During your physical exam, your orthopedic hand specialist will use a variety of diagnostic tests to pinpoint what exactly is causing your hand and arm pain, including:

• Manual sensory testing to evaluate changes in touch or feeling
• Motor testing of the thumb’s abductor pollicis brevis (APB) muscle
• Provocative tests — applying pressure to the median nerve to reproduce symptoms
• Phalen’s test (holding the wrist in a flexed position to see if it triggers numbness or tingling)
• Tinel’s test (tapping over the nerve to create a tingling sensation)
• Compression test (holding pressure over the nerve to see if symptoms appear within 30 seconds)
• Visual inspection for muscle loss at the base of the thumb (thenar atrophy, which may appear in advanced cases)
• Electrodiagnostic studies, such as: Nerve conduction studies, which measure how well electrical signals travel through the median nervean d; Electromyogram (EMG), which records muscle activity and measures the severity of nerve dysfunction

Carpal Tunnel Treatment Options

Once you have a diagnosis, the options for carpal tunnel treatment that can deliver genuine relief begin with resting and properly supporting your wrist.

Non-Surgical Carpal Tunnel Treatment

The goal of any carpal tunnel syndrome treatment is to effectively decrease pressure on the median nerve and improve blood flow to it. The following non-surgical options are often highly effective at alleviating this pressure and improving circulation around the nerve.

• Night-time wrist splint: Holds the wrist in a neutral position during sleep to prevent wrist flexion
• Supportive compression gloves: Fingerless gloves for daytime use during typing or other hand activity (available over the counter; proper fit is essential)
• Over-the-counter pain relievers: NSAIDs like ibuprofen or naproxen reduce inflammation and pain
• Vitamin B6: 100mg – 200mg daily to support nerve health (check with your doctor before use)
• Carpal tunnel exercises: Nerve-gliding and stretching exercises to reduce compression and improve flexibility
• Physical therapy carpal tunnel treatment: includes guided exercises, nerve gliding techniques, and ergonomic adjustments to reduce pressure on the median nerve
• Ultrasound therapy: Uses sound waves to improve circulation and reduce swelling
• Steroid injections: Reduce inflammation and swelling, and can relieve pressure and improve blood flow to the median nerve

It is essential to try these non-surgical treatments for carpal tunnel relief before considering surgery.

Surgical Carpal Tunnel Treatment Options

Continued carpal tunnel syndrome can result in permanent nerve damage. If conservative, non-surgical treatment for carpal tunnel does not relieve your hand and wrist pain, your orthopedic specialist may recommend carpal tunnel surgery. Surgical carpal tunnel syndrome treatments increase the space surrounding the median nerve by carefully cutting the ligament that forms the top of the carpal tunnel. This relieves pressure on the nerve and helps restore normal blood flow and function.

Surgical carpal tunnel treatment options include:

• Carpal tunnel hydrodissection
• Open release carpal tunnel surgery
• Endoscopic carpal tunnel release
• Mini-incision carpal tunnel surgery

Schedule a consultation today with an orthopedic hand surgeon to determine the best treatment for carpal tunnel for your specific case.

What To Expect from Carpal Tunnel Surgery

Carpal tunnel surgeries, such as open release, have a success rate of 95% or higher. The minimally invasive procedure is typically performed at an outpatient surgery center. You can expect:

• 30-minute surgery
• Local or general anesthesia
• Less than a one-inch incision
• Some swelling, pain, and stiffness following the procedure
• May gently use your hand immediately following surgery
• Wearing a splint for one to two weeks
• Physical therapy
• Return to normal activities 6-12 weeks after surgery

Carpal Tunnel Surgery: When Is It Necessary?

Carpal tunnel treatment is crucial because prolonged compression of the median nerve can result in permanent nerve damage. If non-surgical treatment fails to provide carpal tunnel relief, then carpal tunnel surgery may be necessary.

Expert Carpal Tunnel Treatment at Hoag Orthopedic Institute

If you’re living with hand, wrist, or forearm pain, you deserve relief. From diagnosis through physical therapy and conservative care to surgery, Hoag Orthopedic Institute provides expert carpal tunnel treatment tailored to your specific needs.

Contact us to schedule your consultation, and let’s get you back to doing what you love.