Carpal Tunnel Syndrome
The diagnosis is strongly suggested when a nerve
conduction test is abnormal. This test involves measuring the
rate of speed of electrical impulses as they travel down a nerve.
In carpal tunnel syndrome, the impulse slows as it crosses through
the carpal tunnel.
Blood tests may be performed to identify medical
conditions associated with carpal tunnel syndrome. These tests
include thyroid hormone levels, complete blood counts, and blood
sugar and protein analysis. X-ray tests of the wrist and hand
might also be helpful.
How is carpal tunnel syndrome treated?
The choice of treatment for carpal tunnel syndrome
depends on the severity of the symptoms and the underlying disease
causing the symptoms.
Initial treatment usually includes rest, immobilization
of the wrist in a splint, and occasionally ice application. Patients
whose occupations are aggravating the symptoms should modify their
activities. For example, computer keyboards and chair height may
need to be adjusted to optimize comfort. Underlying conditions
or diseases are treated individually. Fractures can require orthopedic
management. Obese individuals will be advised regarding weight
reduction. Rheumatoid disease is treated with measures directed
against the underlying arthritis. Wrist swelling, which can be
associated with pregnancy, resolves after delivery of the baby!
Several types of medications have been used in the
treatment of carpal tunnel syndrome. Vitamin B6 (pyridoxine) has
been reported to relieve some symptoms of carpal tunnel syndrome,
although it is not known how this medication works. Nonsteroidal
anti-inflammatory drugs can also be helpful in decreasing inflammation
and reducing pain. Side effects include gastrointestinal upset
and even ulceration of the stomach. These medications should be
taken with food and abdominal symptoms should be reported to the
doctor. Corticosteroids can be given by mouth or injected directly
into the joint involved. They can bring rapid relief of the persistent
symptoms of carpal tunnel syndrome. Side effects of these medications
when given in short courses for carpal tunnel syndrome are minimal.
However, corticosteroids can aggravate diabetes and should be
avoided in the presence of infections.
Most patients with carpal tunnel syndrome improve
with conservative measures and medications. Occasionally, chronic
pressure on the median nerve can result in persistent numbness
and weakness. In order to avoid serious and permanent nerve and
muscle consequences of carpal tunnel syndrome, surgical treatment
is considered. Surgery involves severing the band of tissue around
the wrist to reduce pressure on the median nerve. This surgical
procedure is called "carpal tunnel release." It can
be performed with a small diameter viewing tube, called an
or by open wrist procedure. After carpal tunnel release, patients
often undergo exercise rehabilitation. Though it is uncommon,
symptoms can recur.
For more information, visit our
Carpal Tunnel Syndrome Forum
Last Editorial Review: 7/11/00
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