Treating Carpal Tunnel Syndrome

From Dr. Z - Carpal tunnel syndrome specialist

Treating Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a condition where the median nerve, which runs through the carpal tunnel inside the wrist, becomes compressed. This can cause pain, numbness, tingling, and weakness in the hand and fingers.


Treating carpal tunnel can be done non-surgically (conservatively) or with surgery. However, studies show that non-surgical remedies provide results that are equal to (and most times, better than) surgery. Since the vast majority or people with carpal tunnel treat it without surgery, this article will focus on those non-surgical treatment options.



Non-surgical options

The vast majority of people (over 95%) who have carpal tunnel syndrome treat it successfully without surgery. When carpal tunnel symptoms are mild, any of the following treatments can work well. However, moderate or severe symptoms will likely require two or more of the following treatments:


1. Nocturnal Wrist Splinting: Wearing a splint at night can help immobilize the wrist and reduce pressure on the nerve.


2. Rest:  Resting your wrist joint for 1-2 weeks should relieve symptoms. More severe symptoms may require even more rest. 


3. Stretching Exercises: Stretching the fingers and hand can make tendons more limber, thereby reducing inflammation inside the wrist joint.


4. Massage Therapy: Massaging the affected area can help improve blood flow and reduce inflammation. 


5. Ergonomic Changes: Adjusting work or home environments to minimize repetitive hand movements and wrist flexion. 


6. Activity Modification: Avoiding activities that worsen symptoms, such as prolonged typing, gripping, or vibrating tools. 


7. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter pain relievers like ibuprofen or naproxen can reduce inflammation and pain. 


8. Corticosteroid Injections: Injections of corticosteroids into the carpal tunnel can provide temporary relief by reducing inflammation. 

man in pain

Effectively treating carpal tunnel without surgery

1. Nocturnal Wrist Splinting (Bracing)

Advantages of night splinting

man sleeping with a wrist brace

Wearing a wrist brace while you sleep is one of the best ways of treating carpal tunnel syndrome. Here's why.


The reason we get carpal tunnel syndrome is because of fluid pressure that's built-up inside the wrist joint. That pressure pushes on the median nerve, thereby damaging it. 


The pressure can be increased even more if you bend your hand forward or backward. And that makes carpal tunnel symptoms much worse. When we sleep we unconsciously hyper-bend our wrists. But wearing a splint while sleeping prevents any hyper-bending. 

Never brace during the daytime

typing with a wrist brace

If you have carpal tunnel syndrome, you should never wear a wrist brace during the daytime (as you work). The reason? Your wrist joint is already damaged by carpal tunnel syndrome. Therefore, while your wrist is trying to perform it's regular activity, it must also fight against the brace's restriction, causing twice the stress.


The only exception to this rule is if you know in advance that you'll be lifting something heavy. (Although you shouldn't do so if you have carpal tunnel syndrome!) The brace can help support your wrist, preventing it from hyper-bending during the lifting.

Use only a "certified" carpal tunnel brace

bad brace

Wearing an ordinary "pharmacy brace" (like those from CVS, Walgreens, etc.) at night for treating carpal tunnel will worsen your symptoms. That's because those braces typically contain a "palmar spine" (see photo). 


If you bend you wrist while sleeping, that spine will push into your joint. This increases pressure inside the wrist, making your carpal tunnel syndrome much worse. 


Below is a list of the most common certified carpal tunnel braces. They are only available online.
List of  "certified" carpal tunnel braces
female hand resting on velvet

2. Rest Your Hand

Almost every disease benefits from rest. Rest is the body's way to combat trauma and restore balance to stressed tissues. Rest also restores blood flow which facilitates oxygen and nutrients.


When treating carpal tunnel with rest you should develop a "rest routine". For instance, for every hour you work with your hands, take a short break. It doesn't mean you have to lie down and sleep. Just a 30 second break from your hand activity will be enough. Better yet, do stretching exercises (see below) during that rest break.

strong man exercising

3. Stretching Exercises

Stretching exercises relieve carpal tunnel syndrome by working at the tissue level (specifically on tendons), from the fingers to the elbow.


If you don't have time for exercises, don't worry. The best carpal tunnel stretching exercises take less than a minute to complete. These are the "core exercises" for carpal tunnel syndrome. The core exercises perform 3 distinct functions. They lubricate flexor tendons, break up fibrous adhesions and restrictions, and enhance blood circulation.


You should do these stretching exercises at least 4 times per day. Also do them after any strenuous hand activity.

Core exercise #1 (Interlace Stretch)

carpal tunnel hand exercise

Lubricating all of your finger tendons simultaneously enhances their gliding abilities. 


Start by interlocking your fingers. Then rotate your wrists so that both palms face outward and in front of you. Straighten your elbows. Hold this position for 10 seconds. Then drop your hands and shake them out.

Core exercise #2 (Stop Stretch)

carpal tunnel hand exercise

This "stop stretch" removes adhesions and restrictions from tendons at the wrist joint.


Hold one hand out in front of you as if you're saying, "Stop!" With the other hand, use all fingers to pull back on the upturned hand. Pull back as hard as you can tolerate. Hold it for 10 seconds. Then drop your hands and shake them out.

Core exercise #3 (Prayer Stretch)

carpal tunnel prayer stretch exercise

This "prayer" stretch affects flexor tendons from the palm to the forearm muscles. 


Begin by pressing your palms together, fingers up, as in a prayer. Keep your hands close to your chest. Then slowly raise your elbows while maintaining your hands at the same level. Lift your elbows as high as you can. Then hold it for 10 seconds. Then drop your hands and shake them out.

Core exercise #4 (Thumb Stretch)

carpal tunnel exercise

The thumb stretch is important because this finger is where most people have the worst carpal tunnel symptoms. So it's important to keep the thumb tendons lubricated and limber.


Grab your opposite thumb and gently pull it backward. Don't over-do it. Pull back and hold for 10 seconds. Then slowly rotate it like a helicopter blade a few times. Then switch direction for a few more rotations. Then drop your hand and shake it out.

4. Massage

Not just any old massage will work

fibrous adhesions on tendons

One of the most effective carpal tunnel treatments is massage. But not just any old massage will work. In fact, some types (like vibration massage) can be harmful if you have carpal tunnel. 


Instead, you must use a specific technique called myofascial release massage. When properly performed, it has a 97% effectiveness rate against carpal tunnel syndrome.


Myofascial massage facilitates lymphatic drainage and breaks up adhesions that cause restrictions around tendons.

More effective than surgery

myofascial release massage

At it's core, carpal tunnel syndrome is due to swollen tendons. Tendons swell because they acquire fibrous adhesions on their surface which restricts their motion. So the key to reducing tendon swelling is to destroy the adhesions.


Myofascial release massage destroys these adhesions using counter-rotating fingers. The counter-rotating thumbs and forefingers of the therapist create a "kneading" motion. 


Myofascial release massage PLUS nocturnal bracing is more effective than surgery. The only downside is that visiting a therapist once or twice daily for 30 days is expensive. Note that the CarpalRx device performs this identical massage automatically and in your own home.
ergonomic mouse

5. Ergonomic Changes

Anyone can eliminate or greatly reduce carpal tunnel symptoms by simply adjusting their work or home environments. The adjustments should minimize repetitive hand movements, wrist flexion, and other harmful hand activities.


Pay attention to how you sit (or stand) while working. Is your chair comfortable and at the right level? Is there a tool or method to perform the same job with fewer or less strenuous movements?


Most people who type on a computer benefit greatly from an ergonomic mouse and keyboard. Virtually all keyboard and mouse designs do similar things, so your particular "comfort" preference is important. Test several models to make sure it's right for you.

hands typing on a keyboard

6. Activity Modification

If you have signs of carpal tunnel syndrome it's likely the activity you do every day is causing it. Therefore, avoid the obvious hand stressing activity or activities such as prolonged typing, gripping, or using vibrating tools. 


Taking frequent rest breaks, especially resting AND doing stretching exercises is a good way to start. If you job requires using tools or lifting loads, try wearing thick gloves. Think of ways to do the same job but with less strain on your upper body.

NSAID drugs

7. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Non-Steroidal Anti-Inflammatory Drugs or NSAIDs include over-the-counter pain relievers like ibuprofen (Advil), naproxen (Aleve), or acetaminophen (Tylenol). They can reduce inflammation and pain. 


Pain relievers are only a temporary solution to carpal tunnel syndrome. They never should be taken for long periods of time due to their potential for kidney and liver damage.

carpal tunnel steroid injection

8. Corticosteroid Injections

Some doctors prefer to use injections of corticosteroids directly into the carpal tunnel space. This can provide temporary relief by reducing inflammation. However, there are two main problems with corticosteroid injections.


First, the injections are successful in only about 45% of patients. And the more severe you symptoms, the less effective the effects of the injection.


Second, corticosteroid injections are only a temporary solution. When they do work well, the effect lasts from 2-4 months. That means symptoms return as before. But the problem is that corticosteroid injections cannot be used often because of their significant side effects, like bone loss and weight gain. Thus, using a second or third injection must be carefully considered.

Conclusion

The most effective way of treating carpal tunnel syndrome is with non-surgical remedies. These include night splinting, rest, stretching exercise, and massage, among others. Mild cases of carpal tunnel syndrome may be relieved quickly using any one of these therapies. But more severe symptoms likely require multiple therapies applied simultaneously.