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Common Diseases > Carple Tunnel Introduction Stress Anatomy Diet Prevention and Treatment Surgery In the early stages of carpal tunnel syndrome, a simple brace will sometimes decrease the symptoms, especially the numbness and pain occurring at night. These braces simply keep the wrist in a neutral position (not bent back too far nor bent down too far). When the wrist is in this position, the carpal tunnel is as big as it can be - so the nerve has as much room as possible. The brace needs to be worn at night while you sleep to prevent the numbness and pain occurring at night. If you have symptoms during the day as well, the brace may help reduce those symptoms as well. Anti-inflammatory medications may also help control the swelling of the tenosynovium and reduce the symptoms of carpal tunnel syndrome. These medications include the common over the counter medications such as ibuprofen and aspirin. In some studies, high doses of Vitamin B-6 have also shown some efficacy in decreasing the symptoms of carpal tunnel syndrome. If these simple measures fail to control your symptoms an injection of cortisone into the carpal tunnel may be suggested. This medication will decrease the swelling of the tenosynovium and may give temporary relief of symptoms. It is used not only to treat the problem, but serves to aid in diagnosis. If you don't get even temporary relief from the injection, it may be a sign that other problems exist that are causing the carpal tunnel symptoms. There is also a newer way to get cortisone medications down into the carpal tunnel. Lontophresis is a technique where an electrical current is used to move the molecules of the medication through the skin down into the carpal tunnel. It is less painful than an injection, but is probably not as effective. Surgical Treatment If all of the previous treatments fail to control the symptoms of carpal tunnel syndrome, surgery may be required to reduce the pressure on the median nerve. There are several different surgical procedures designed to relieve pressure on the median nerve. The most common are the traditional open incision technique described below, and the newer Endoscopic Carpal Tunnel Release using a smaller incision and a fiberoptic TV camera to help see inside the carpal tunnel. Basic Steps in Open Carpal Tunnel Release Step 1 A small incision, usually less than 2 inches, is made in the palm of the hand. In some severe cases, the incision needs to be extended into the forearm another 1/2 inch or so. Step 2 After the incision is made through the skin, a structure called the palmar fascia is visible. An incision is made through this material as well, so that the constricting element, the transverse carpal ligament, can be seen. Step 3 Once the transverse carpal ligament is visible, it is cut with either a scalpel or scissors, while making sure that the median nerve is out of the way and protected. Step 4 Once the transverse carpal ligament is cut, the pressure is relieved on the median nerve. Step 5 Finally, the skin incision is sutured. At the end of the procedure, only the skin incision is repaired. The transverse carpal ligament remains open and the gap is slowly filled by scar tissue. A bulky dressing is applied to the hand following surgery. You should leave this in place until your first office visit after the surgery. Your sutures will be removed 10 - 14 days after surgery. You should avoid any heavy use of the hand for 4 weeks after your surgery. You should not get the stitches wet. Expect the pain and numbness to begin to improve after surgery, but you may have tenderness in the area of the incision for several months. Please consult a physician for specific treatment recommendations Introduction | Stress | Anatomy | Diet | Prevention and Treatment | Surgery |
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