Peer Reviewed Patient Education

This first level of treatment is the most conservative.

A wrist splint is used to hold the wrist in a straight position. The splint is usually worn during sleep. When sleeping, it is natural to curl up with the wrists bent. This position places pressure on the median nerve causing the symptoms of numbness and tingling to flare up. The use of a splint often reduces these symptoms. Many patients like to wear the splint during the day, as well. Extreme positions that put pressure on the nerve should be avoided.

Oral anti-inflammatory medication, such as ibuprofen, may help reduce the swelling around the tendons. Once the swelling is reduced and pressure is taken off the median nerve, symptoms usually lessen. The most common side effect from ibuprofen is an upset stomach. Taking the medication with food reduces that possibility.

Activities that cause irritation of the area should be avoided. There are many activities associated with carpal tunnel syndrome. Whether these activities cause CTS is still unknown. Nevertheless, repetitive tasks that make symptoms worse should be avoided. Computers, ten key, cash registers, assembly lines, and meat cutting are just some of the suspected activities. Computer use is commonly blamed for aggravating CTS. It is important that the workstation be arranged to avoid awkward postures. Patients should take frequent breaks from the computer (at least 5 minutes every half-hour) and, as much as possible, avoid long hours at the computer. During these breaks, stretching exercises can be helpful.

Less than half of CTS patients (about 20% to 50%) become symptom-free with the most conservative treatment. A steroid injection to reduce inflammation is typically the next step if symptoms are not controlled by the above treatments. The doctor injects the medicine into the tunnel using a very small needle.

The success rate for patients receiving injections is again relatively low, as only 20% to 50% of patients get relief from an injection. The condition may improve temporarily, but symptoms often return. Injections are more successful in patients over 60 - 70 years of age than in the younger population. Patients who experience some improvement with the injection tend to benefit from surgery, as the improvement indicates that swelling and pressure were the causes of the problem. If there is no noticeable improvement after the injection, other conditions causing the symptoms should be considered.

What types of complications may occur?

Complications from non-operative treatment are few and rare. Taking anti-inflammatory medication may cause the patient to experience an upset stomach, or possibly develop an ulcer. The only significant risks are associated with the steroid injection, and these are small. These risks include infection, weakening of the tendons, and possible damage to the nerves or blood vessels. The most common problem of conservative treatment is the failure to relieve the symptoms. As earlier mentioned, only about half, or less, of CTS patients have success with the non-operative treatment method.