Treatment

Treat carpal tunnel syndrome as early as possible after symptoms start. In the early stages, simple things that you can do for yourself may make the problem go away. For example:

• Take more-frequent breaks to rest your hands.
• Avoid activities that make symptoms worse.
• Apply cold packs to reduce swelling.

Other treatment options include wrist splinting, medications and surgery. Splinting and other conservative treatments are more likely to help if you've had only mild to moderate symptoms that come and go for less than 10 months. If you have numbness in your hands, you need to see a doctor.

Nonsurgical therapy

If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel syndrome, including:

• Wrist splinting. A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness. Even though you only wear the splint at night, it can also help prevent daytime symptoms. Nighttime splinting may be a good option if you're pregnant because it does not involve the use of any medications to be effective.

• Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen (Advil, Motrin IB, others), may help relieve pain from carpal tunnel syndrome in the short term.

  There isn't evidence, however, that these drugs improve carpal tunnel syndrome.

• Corticosteroids. Your doctor may inject your carpal tunnel with a corticosteroid such as cortisone to relieve pain. Sometimes your doctor uses an ultrasound to guide these injections.

  Corticosteroids decrease inflammation and swelling, which relieves pressure on the median nerve. Oral corticosteroids aren't considered as effective as corticosteroid injections for treating carpal tunnel syndrome.

If carpal tunnel syndrome is caused by rheumatoid arthritis or another inflammatory arthritis, then treating the arthritis may reduce symptoms of carpal tunnel syndrome. However, this is unproved.

Surgery

Surgery may be appropriate if your symptoms are severe or don't respond to other treatments.

The goal of carpal tunnel surgery is to relieve pressure by cutting the ligament pressing on the median nerve.

The surgery may be performed with two different techniques:

• Endoscopic surgery. Your surgeon uses a telescope-like device with a tiny camera attached to it (endoscope) to see inside your carpal tunnel. Your surgeon cuts the ligament through one or two small incisions in your hand or wrist. Some surgeons may use ultrasound instead of a telescope to guide the tool that cuts the ligament.

  Endoscopic surgery may result in less pain than does open surgery in the first few days or weeks after surgery.

• Open surgery. Your surgeon makes an incision in the palm of your hand over the carpal tunnel and cuts through the ligament to free the nerve.

Discuss the risks and benefits of each technique with your surgeon before surgery. Surgery risks may include:

• Incomplete release of the ligament
• Wound infections
• Scar formation
• Injuries to the nerves or blood vessels

During the healing process after the surgery, the ligament tissues gradually grow back together while allowing more room for the nerve. This internal healing process typically takes several months, but the skin heals in a few weeks.

Your doctor generally will encourage you to use your hand after the ligament has healed, gradually working back to normal use of your hand while initially avoiding forceful hand motions or extreme wrist positions.

Soreness or weakness may take from several weeks to a few months to resolve after surgery. If your symptoms were very severe, symptoms may not go away completely after surgery.