Carpal tunnel syndrome (CTS) is caused by compression and irritation of the nerves in the wrist causing pain, numbness, tingling and/or weakness in the wrist and hand. Repeated muscle strain/sprains, fractures, abnormal wrist anatomy, and other conditions that reduce the distance between the carpal tunnel and increase the risk of CTS. Symptoms of CTS can often be managed at home, although sometimes medical treatment is required for complete recovery.
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Part 1 of 2: Coping with CTS at Home
Step 1. Avoid compression on your median nerve
The carpal tunnel inside the wrist is a canal made of small carpal bones attached to ligaments. This passageway protects the nerves, blood vessels, and tendons. The main nerve responsible for movement and sensation in your hand is the median nerve. Therefore, avoid activities that compress and irritate the median nerve, such as repeatedly tightening your wrist, lifting heavy weights, sleeping with your wrist bent and punching solid objects.
- Make sure you don't wear the watch and the bracelet is too tight on the wrist so as not to irritate the median nerve.
- In more severe cases of CTS, the underlying cause is difficult to pinpoint. CTS is usually caused by a combination of factors, such as wrist strain with arthritis or diabetes.
- The anatomy of the wrist can have an effect. Some people naturally have smaller passageways or abnormally shaped carpal bones
Step 2. Stretch your wrist regularly
Stretching the wrist daily will help reduce or minimize the symptoms of CTS. In particular, lengthening your wrist helps you open up space for the median nerve in the carpal tunnel by stretching the ligaments around it. The best way to stretch both wrists at once is to do the “praying posture.” Place your palms together about 15 cm in front of your chest. Hold for 30 seconds and repeat 3-5 times each day.
- Alternatively, clasp the fingers on the affected hand, and pull until they feel a stretch in the front of the wrist.
- Wrist stretching may temporarily trigger CTS symptoms, such as a tingling feeling in the hand, but don't stop unless it hurts. These symptoms will disappear over time.
- Apart from tingling, other symptoms commonly associated with CTS include numbness, throbbing pain, weakness and/or muscle discoloration (too pale or red).
Step 3. Shake your hands
If you notice (both) hands are asleep or feel pain in the wrist, temporarily relieve yourself by shaking your hands for 10-15 seconds as if you were drying the water on your hands after washing your hands. This movement will improve blood circulation and nerve flow in the median nerve and temporarily relieve the symptoms of CTS. Depending on your job, you may need to shake your hands frequently throughout the day to treat CTS symptoms.
- Symptoms of CTS often appear (and begin) on the thumb, index finger, middle finger, and parts of the ring finger. This is why people with CTS often drop things or appear careless.
- The little finger is the only finger that is not affected by CTS because the median nerve is not traversed.
Step 4. Wear a special wrist support
A semi-rigid wrist brace, brace, or splint will help prevent CTS symptoms by keeping the wrist in a neutral position and preventing it from straining. A splint or brace should also be worn during activities that could potentially exacerbate the injury, such as typing, carrying groceries, driving, and bowling. Use during sleep will help relieve symptoms that appear at night, especially if you usually sleep with your hands tucked into your body.
- You may need to use a wrist brace for several weeks (day and night) for the symptoms of CTS to significantly subside. However, for some, these accessories are of little help.
- Wear a wrist splint at night if you are pregnant and have CTS because pregnancy tends to increase swelling in the hands (and feet).
- Wrist braces, splints, and braces can be purchased at pharmacies or sports stores.
Step 5. Consider changing sleeping positions
Some sleeping postures can exacerbate CTS symptoms, thereby reducing the quality of your sleep. More specifically, sleeping with your arms clenched or tucked into your body (wrist tension) is the worst position to trigger CTS. In addition, extending your arms above your head is also not a good sleeping position. Sleep lying down or on your side with your arms close together, keeping your arms open and your wrists in a neutral position. This position will facilitate blood circulation and nerve flow.
- As mentioned above, wearing a wrist support while sleeping will help prevent a bad sleeping position, but it will take some time to get used to it.
- Don't sleep on your stomach with your wrists compressed (stressed) under the pillow. Usually, people who sleep with the position awake in a state of numbness and tingling in his hands.
- Most wrist supports are made of nylon and fastened with velcro, which can cause skin irritation. Therefore, cover your support with a sock or cheesecloth to reduce irritation.
Step 6. Take a close look at your workplace
In addition to sleeping position, CTS symptoms can also be caused or triggered by poor workplace design. If your computer keyboard, mouse, desk or chair don't match your height and body proportions, your wrists, shoulders, neck, and mid-back will strain. Therefore, make sure the keyboard is positioned properly so that the wrist does not continue to extend back while typing. Consider purchasing an ergonomic keyboard and mouse designed to reduce stress on the hands and the wrist. Perhaps, these costs can be borne by your office or boss.
- Place a thin pad under the keyboard and mouse to reduce impact on the hands and wrists.
- Ask an occupational therapist to review your workplace and refer to the ergonomic changes that need to be made for your body.
- People who work in front of computers and counters (eg cashiers) are more prone to CTS.
Step 7. Buy a commercial drug
The symptoms of CTS are often related to the inflammation/swelling that develops in the wrist, thereby contributing to damage to the median nerve and surrounding blood vessels. Therefore, take an NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen or naproxen to relieve the symptoms of CTS, at least temporarily. Pain relievers, such as acetaminophen, can also counteract the pain of CTS, but have no effect on inflammation/swelling.
- NSAIDs and analgesics should only be a short-term solution for pain control. There is no evidence that these medications cure or relieve CTS in the long term.
- Taking NSAIDs for too long (or too many at once) significantly increases the risk of stomach irritation, ulcers, and kidney failure. Always follow the dosage on the package.
- Taking too much acetaminophen can damage the liver.
Part 2 of 2: Obtaining Medical Treatment for CTS
Step 1. Make an appointment with your family doctor
If you experience any of the things mentioned above, for more than a few weeks, see a doctor for a checkup. The doctor will examine and may take x-rays to rule out diseases similar to CTS, such as arthritis (rheumatoid arthritis), osteoarthritis, diabetes, stress fractures in the wrist or vascular problems.
- Electro-diagnostic tests (EMG and nerve conduction) are often performed to confirm the diagnosis of CTS by measuring median nerve function.
- You may be asked to perform specific tasks that are difficult for people with CTS to do, such as tightly clenching your fists, pressing your thumb to your index finger firmly, and moving small objects carefully.
- Your doctor may ask you about your occupation because some occupations are highly susceptible to CTS, such as carpenters, cashiers, assembly line workers, musicians, car mechanics, and people who use computers a lot.
Step 2. See a health professional such as a physical therapist or massage therapist
- Physical therapy. Often, symptoms of CTS can be treated conservatively. A physical therapist (or physiotherapist) will examine your joints, muscles, and ligaments to look for the underlying cause of carpal tunnel symptoms. Treatments may include modalities such as ultrasound to relieve inflammation, and ergonomics education to assess and change the workplace or daily activities to reduce stress.
- Massage therapy. In some cases, the symptoms of carpal tunnel syndrome can be associated with myofascial pain syndrome (Myofascial Pain Syndrome), a condition associated with the presence of trigger points, or more commonly known as muscle knots. Research shows that many people with carpal tunnel symptoms have trigger points. In addition, studies have found that treatment of these nodes helps relieve CTS symptoms.
Step 3. Try corticosteroid injections
Your doctor may suggest treatment with corticosteroid injections (such as cortisone) into the wrist or base of the hand to relieve pain, inflammation, and other symptoms of CTS. Corticosteroids are powerful and fast-acting drugs that can reduce swelling in the wrist and relieve pressure on the median nerve. Another option is to take dietary steroids, but they are not as effective as injectable steroids. In addition, you are more prone to side effects.
- Other steroids commonly used for the treatment of CTS include prednisolone, dexamethasone and triamcinolone.
- Complications that may be associated with corticosteroid injections include local infection, excessive bleeding, weakening of the tendons, muscle atrophy, and nerve damage. Therefore, injections are usually limited to only 2 times a year.
- If steroid injections do not significantly reduce CTS symptoms then consider surgery.
Step 4. Consider carpal tunnel surgery as a last resort
If all home remedies fail to relieve the symptoms of CTS, your doctor may suggest surgery. Surgery should be the last option because of the risk of further damage, although it can significantly reduce the patient's symptoms. The goal of CTS surgery is to relieve pressure on the median nerve by cutting the primary ligament that compresses the nerve. CTS surgery can be performed in two ways: endoscopic and open surgery.
- Endoscopic surgery involves using a thin, telescope-like instrument with a tiny camera on the end (endoscope) that is inserted into the carpal tunnel through an incision in the wrist or palm. The endoscope also allows the surgeon to see inside the carpal tunnel and cut the problem ligaments.
- Endoscopic surgery usually causes less pain and side effects, and the fastest healing time.
- In contrast, open surgery involves a larger incision in the palm and above the wrist to cut the ligaments and free the median nerve.
- The risks of surgery consist of: nerve damage, infection, and tissue wound formation. All of which have the potential to exacerbate CTS.
Step 5. Be patient during the operation
During outpatient CTS surgery, you will be asked a lot to raise your hand above your heart and move your fingers, which helps reduce swelling and prevent stiffness. Mild pain, inflammation, and hand/wrist stiffness are common after surgery up to 6 months later, and complete recovery usually takes one year. For the first 2-4 weeks postoperatively, you will be asked to wear a wrist support, although using your hands is not recommended.
- Most CTS symptoms improve after surgery, but recovery is often slow and gradual. Hand strength usually returns to normal 2 months after surgery.
- CTS recurs in about 10% after surgery and may require follow-up surgery months or years later.
Tips
- Most people with CTS do not work at a computer or do repetitive physical work. There are a variety of other causes and risk factors for CTS.
- You are more susceptible to CTS if you use equipment that vibrates. Therefore, take frequent breaks.
- You are more prone to experiencing hand/wrist symptoms in a cold environment. Therefore, keep your arms warm as much as possible.
- Vitamin B6 supplements are said to be able to relieve CTS symptoms in some people, although the reason is not yet known. B6 intake that is too high can cause numbness and tingling in the limbs.
- After carpal tunnel surgery, you may still experience numbness for up to 3 months while you recover.
