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NON-SURGICAL TREATMENTS

Symptoms of CTS can often be relieved without surgery.

The initial conservative treatment for CTS is to combine taking NSAIDs like Motrin and
Naproxen and wearing Resting Hand Splints (RHS). The combination may or may not help.
The patient continues the medication and the splints for two weeks, because research
shows there is no additional benefit from using the RHS for more than two weeks. The initial
approach attempts to decrease nerve and carpal tunnel inflammation.

The purpose of using NSAIDs is to decrease inflammation in the structures of the hands and
wrists. There are risks with the use of NSAIDs included but not limited to developing
stomach ulcers, kidney problems and bruising from the blood thinning effect of NSAIDs.
Consult your physician.

RHS is a passive treatment used to limit range of motion of the hands and hand flexion or
extension at night but they do not alter mechanics. Hand splints may alleviate the
symptoms, but they do not treat what is actually causing the symptoms, which is a narrow
tunnel. Research on RHS shows it may be beneficial for the first two weeks of use. After
that it may even be detrimental.

CORTISONE INJECTIONS have also been used to control pain from CTS. They help a
large number of patients, but in many cases, the symptoms recur. There are multiple
reasons for this. Physicians usually recommend these patients proceed with carpal tunnel
release or carpal tunnel release surgery to attempt to decompress and open their carpal
tunnel.

NSAIDS and steroid injections decrease inflammation, but do not address the main
problem, which is a narrow tunnel. In addition to stomach ulcers, NSAIDs and injections can
increase blood sugar levels. Both of them may temporarily help your symptoms but because
the size of the tunnel is not increased, you will likely have a recurrence of symptoms once
you stop the treatments, and potentially will be recommended for surgery.

ACUPUNCTURE is occasionally used to treat CTS. Again it does not address a narrow
carpal tunnel and the relief is short-lived. Acupuncture works by releasing endorphins (a
morphine-like substance) in the spinal cord. Endorphins block the transmission of pain. The
endorphins will be dissolved/reabsorbed within a few days; then the symptoms come back.
After these initial treatments, ideally the patient is referred to a Neurologist or Physiatrist
(PMR) specialist. At this point, it is appropriate for the physician to confirm the diagnosis.
The physician performs a test called a electromyography/nerve conduction study. This test
evaluates the median nerve and the cervical spine or neck nerves to evaluate for damage or
nerve impingement. After the test, the physician makes a diagnosis and the patient is
started in physical or occupational therapy. Again the approach attempts to decrease
inflammation.

PHYSICAL THERAPISTS AND OCCUPATIONAL THERAPISTS understand CTS is a
mechanical problem in which the nerve is compressed by the carpal tunnel. They do try to
open the Carpal Tunnel but they are limited to office visits for their attempt to open the tunnel.
Four to Six weeks of therapy are done.  

The patient is then referred to an orthopedic surgeon if he or she has not been referred yet.
The surgeon will establish that conservative therapy was tried and failed; thus the patient
needs surgery. The likelihood of having carpal tunnel release surgery is 53 to 129 percent
higher if the surgeon has a financial interest in the surgery center where the surgery is to
be performed.

CTS is a mechanical problem. Unfortunately current conservative treatments do not alter
mechanics. Current treatments attempt to control the symptoms of CTS without taking the
pressure off the nerve, by addressing inflammation with NSAIDs, injections, RHS, ergonomic
keyboards, etc. Physicians and therapists try to control symptoms of CTS by immobilizing,
limiting range of motion or decreasing inflammation. They do NOT attempt to increase the
area of the carpal tunnel.

READ MORE ABOUT SURGICAL OPTIONS ยป
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