Nonsurgical Options to Treat Carpal Tunnel SyndromeSurgery for the repetitive stress injury, carpal tunnel syndrome, isn't always the best approach. Some patients, for a variety of reasons, either shouldn't have, don't yet need, or can't have surgery. For this reason, it's important to look for alternative, nonsurgical approaches to treatment. The author of this article asks the question, "What is the best nonsurgical treatment for carpal tunnel syndrome?"
Treating carpal tunnel syndrome starts with looking at the goal. What is the outcome the doctor and patient expect from the treatment plan? While it may seem that the goal is the same for everyone, this isn't always so. For example, if your priority is to return to your previous activities without any symptoms as soon as possible, surgery may be the answer. But if you have the time to work on your treatment, your doctor may want to try the other options. These include medications, either injected directly into the area (such as steroids) or oral medications to help relieve pain and inflammation, to lifestyle changes and splinting.
Splinting your wrist makes it so you can't move your hand in the motion that irritates the nerve that is running through the carpal tunnel. This allows the inflammation to go down and relieve pain and symptoms. Several studies have been done to see how effective splinting is in treating carpal tunnel syndrome and the results aren't clear. The studies were too small or didn't have enough evidence to come to a strong conclusion.
Some doctors have used ultrasound to treat carpal tunnel syndrome and at least two studies have found that, compared with fake ultrasound (placebo), the ultrasound helped the patients. Another study compared ultrasound to laser and the ultrasound came out ahead. Other treatments didn't show any impressive results or hadn't been studied enough to provide good results. These include treatments such as heat therapy, therapeutic touch, chiropractics, and iontophoresis (electrical currents).
Medications such as steroids can be given either by mouth or injection directly to the problem area. Both aim to reduce inflammation. Oral steroids compared against placebos did show good effect at reducing symptoms, but the long-term effects weren't there. Plus, doctors have to be wary of providing steroids for long periods because of the effects steroids can have on the rest of the body. The injectable type of steroids has been looked at in several studies. There have been good effects in the short-term (two to four weeks) and have been found better at three months than oral steroids. One study found that combining steroid injections with splinting provided good responses as far as six months down the road, when compared to just splinting alone. There is debate as to whether injecting steroids is worth it because the long-term effects aren't well known.
Diuretics (so-called water pills) may be tried, along with nonsteroidal anti-inflammatory drugs (NSAIDs). The studies for this treatment have been too short or too small to draw any conclusions.
The author writes that there is precious little in the way of consisted research into the treatment of carpal tunnel syndrome. He cites a case that he uses and example, of a 45-year-old patient who sought help because she had intermittent pain and numbness in her right hand, bothering her more at night than during the day. Although her family doctor had tested her and found that there was a problem with the nerve that passes through the carpal tunnel, her doctor hadn't yet suggested any treatments.
By not having adequate studies and not being able to measure outcomes, doctors are at a disadvantage. They can't learn what has worked for others and different approaches that may fit their particular patient. Another area lacking in research is the history of the disorder. While some people are at higher risk of developing a repetitive stress disorder, some people are more at risk than others. Why is that? Studies on this would provide valuable information to both treating doctors and other researchers.
In conclusion, using the knowledge that is provided by the studies, the author explains that to treat the patient in the case study, he would choose night-time splinting for six weeks. If this splinting was successful in relieving symptoms, the splint would be gradually removed over time until it wasn't needed any more. The splint could be reused over the next six to 12 weeks if needed. If, however, the splinting didn't work, then he would likely recommend surgery or, although he's not in favor of it himself, steroid injection in addition to splinting, for a longer period.
Brent Graham, MD. Nonsurgical Treatment of Carpal Tunnel Syndrome. In The Journal of Hand Surgery. March 2009. Vol. 34. No. 3. Pp. 531-534.
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