it should be emphasized that even when carpal tunnel syndrome presents with mild symptoms, it’s important to try to modify and assess really what was the underlying cause of the carpal tunnel syndrome and to modify those activities. Whether they’re at the workplace, if we can modify the way that someone is sitting at their desk and in front of the computer, if they’re doing any type of repetitive motion that is putting their wrists into a position of flexion — of extension or flexion, modification of those activities during the day will really be the best approach to keep the carpal tunnel syndrome from coming back.
When treating carpal tunnel syndrome, if the symptoms are mild, typically we initially recommend wearing neutral resting wrist splints. And the purpose of these splints is to bring your wrists back into a neutral position which will likely minimize the amount of pressure you’re putting on the nerve to prevent it from going into this position or this position. They can be worn during the day if you’re going to be in front of the computer. They can be worn at night also when commonly patients might put their wrist into a position that puts pressure on the wrist.
Second, we can also do a image guided injection again under ultrasound when you can nicely visualize the median nerve in real time and to visualize the surrounding tendons of the thumb and the fingers. By putting a little bit of medication that includes steroid and lidocaine around the nerve, typically this will reduce the inflammation and the swelling that’s surrounding the median nerve and can reduce the symptoms of carpal tunnel.
In addition to the splint and the injection, physical therapy also is very beneficial to strengthen the muscles surrounding the wrist and optimize the muscles to make the muscles do the work rather than putting pressure on the joints and the nerve itself.
When carpal tunnel syndrome is severe as diagnosed from the electromyographic studies, or when injections, physical therapy, and resting, neutral wrist splints, haven’t helped sufficiently, then a surgical treatment is to release the tunnel and basically to reduce pressure by opening the carpal tunnel itself and trying to relieve the pressure on the median nerve.