Houston Methodist. Leading Medicine

Hand FAQ

Question:

I was just diagnosed with carpal tunnel syndrome in both wrists and hands (worse on the right side). I'm not sure what to do next. Should I just go for the surgery? Or wait and see if it gets better with rest and physical therapy?

Answer:

Carpal tunnel syndrome is a common problem affecting the hand and wrist. Symptoms begin when the median nerve gets squeezed inside the carpal tunnel of the wrist, a medical condition known as nerve entrapment. Any condition that decreases the size of the carpal tunnel or enlarges the tissues inside the tunnel can produce the symptoms of CTS. This syndrome has received a lot of attention in recent years. Many people thought it might be linked with occupations that require repeated use of the hands. The number of patients with CTS seemed to be increasing as more people were spending time typing on a computer keyboard or doing assembly work. Actually, many people develop this condition regardless of the type of work they do. The American Association of Orthopaedic Surgeons (AAOS) recently put together a special committee to develop a clinical practice guideline on the treatment of carpal tunnel syndrome (CTS). The Guideline Workgroup worked together reviewing the most up-to-date evidence collected from clinicians and researchers to guide them. They reported that once the diagnosis is made, conservative (nonoperative) care is the first step. Many types of nonoperative treatment are available. So far, there isn't enough evidence for or against their use, so there isn't a one-treatment-fits-all approach. Conservative care includes such things as physical therapy, acupuncture, electrical stimulation, nutritional supplements, yoga, or magnet therapy. If conservative care does not improve your symptoms within two to seven weeks, then try a different nonoperative approach. Splinting or steroids (oral or injections) are two treatment possibilities that have shown successful results. Heat should not be used to treat this problem. Surgery is considered an option when electrodiagnostic tests show that the median nerve is damaged. Usually, the surgeon performs a carpal release. The band of connective tissue that goes across the wrist over the carpal tunnel area is cut (released) to take pressure off the median nerve as it goes through the carpal tunnel. Be sure and ask your physician what recommendations he or she has. Sometimes there are specific circumstances (e.g., in your health or the cause of your symptoms) that direct treatment. You may be able to save yourself some time and money by taking this approach. Fareeha Shuttari-Khan, MPH. AAOS Adopts CTS Clinical Treatment Guidelines. In AAOSNow. October 2008. Vol. 2. No. 10. Pp. 1, 10.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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