It should be emphasized that even when carpal tunnel syndrome presents with mild symptoms, it’s important to try to assess what is the underlying cause of the carpal tunnel syndrome and to modify those activities. If it’s at the workplace, we can modify the way that someone is sitting at their desk and in front of the computer, or if they’re doing any type of repetitive motion that is putting their wrists into a position of flexion or extension, modification of those activities during the day will be the best approach to keep those symptoms from coming back.
When treating carpal tunnel syndrome, if the symptoms are mild, we initially recommend wearing neutral resting wrist splints. The purpose of these splints is to bring your wrists back into a neutral position which will likely minimize the amount of pressure you’re putting on the nerve to prevent it from going into this position or this position. They can be worn during the day if you’re going to be in front of the computer. They can be worn at night also when patients might put their wrist into a position that puts pressure on it.
We can also do an image guided injection under ultrasound so that we can nicely visualize the median nerve in real time and visualize the surrounding tendons of the thumb and fingers. By putting a little bit of medication that includes steroid and lidocaine around the nerve, this will reduce the inflammation and the swelling that surrounding the median nerve and can reduce the symptoms of carpal tunnel.
In addition to splints and injections, physical therapy is also very beneficial to strengthen the muscles surrounding the wrist and optimize the muscles and make the muscles do the work rather than putting pressure on the joints and the nerve itself. When carpal tunnel syndrome is severe as diagnosed from the electromyographic studies, or when injections, physical therapy, resting, and neutral wrist splints have not helped sufficiently, then a surgical treatment is to release the tunnel and reduce pressure by opening the carpal tunnel itself to try to relieve the pressure on the median nerve.