I’m writing this article for people who want to avoid carpal tunnel surgery. Yes, I am an orthopedic surgeon and I’m trained to operate on patients with carpal tunnel syndrome (CTS). But I’m also a physician, and part of our jobs as physicians is to educate patients about prevention of disease. Hopefully I can teach people about ways to reduce their risk and provide more options for treatment prior to requiring surgery. Unfortunately, prevention and wellness are not emphasized by the healthcare system in our country. Oftentimes we are incentivized to treat a disease once it appears, not to prevent it altogether.
As a disclaimer, patients who have severe carpal tunnel syndrome should be evaluated promptly and not delay treatment unnecessarily. Constant numbness in the hand and loss of muscle mass at the base of the thumb are signs of nerve damage and severe CTS. Surgery is the best way to prevent the nerve from being damaged irreversibly. If people wait too long before having surgery, some of the hand numbness can be permanent.
Also, not all hand pain, numbness, and tingling are caused by CTS. If your symptoms are progressive, severe, or not responding to treatment, get an evaluation by a hand specialist or primary care physician sooner rather than later.
The recommendations below are intended for patients with mild to moderate CTS symptoms, or in people who want to prevent the symptoms from occurring in the first place. There are some things we can’t change about our health, such as our family history, age and anatomy, but there are many things which we can modify.
Helpful things to do other than surgery for carpal tunnel syndrome:
- Wear a wrist brace at night
- Hand and wrist stretching exercises during the day
- Increase physical activity and exercise
- Weight loss
- Modify hand activities
- Learn healthy computer habits
- Consider Vitamin B6 supplements
- Stop tobacco use
- Get a steroid injection from a physician
Treatments which are NOT helpful for CTS:
- Magnet therapy
- Laser therapy
- Long-term use of oral NSAIDs
- Expensive custom braces
- Most things on the internet from someone trying to sell you something
Here is some background information about the carpal tunnel anatomy, which will help you understand what is going on. The nerve which supplies most of the feeling to the hand is called the median nerve. This nerve travels through the carpal tunnel in the palm side of the wrist. The carpal tunnel is a tight oval-shaped space, and it is made up of the carpal bones of the wrist and strong ligaments. The tendons which move the thumb and fingers also travel through the carpal tunnel. Each finger has 2 tendons and the thumb has one tendon. In total, 9 tendons and the median nerve are within the carpal tunnel. In addition to supplying the feeling to the hand, the median nerve also controls the muscles at the base of the thumb.
If there is swelling or inflammation around the tendons, the carpal tunnel becomes crowded. That crowding puts extra pressure on the nerve in the carpal tunnel, and the nerve gets pinched. Nerves are delicate and they do not like to be compressed. Patients experience hand numbness, tingling, pins and needles, electric shocks, swelling, and weakness when a nerve is pinched. The feeling in the pinky finger is supplied by a different nerve, and that is why this finger is usually not numb in patients with CTS. Symptoms are often worse at night. In addition, the pain can radiate up the arm, waking the patient up from sleep.
Wearing a brace at night
Most people, including myself, sleep with the wrist bent. When the wrist is not kept straight, the pressure within the carpal tunnel increases. Therefore, when the wrist is bent for a long period of time, such as during sleep, the nerve is compressed. This causes symptoms at night. The simplest treatment is to use an over-the-counter wrist brace to keep the wrist straight and train yourself not to keep the wrist bent during sleep. Otherwise you’ll wake up with the hand numb/tingly and have to reposition your arm and shake out the numbness to get the feeling back.
Hand and wrist stretches
A physical therapist, occupational therapist, or certified hand therapist can teach you exercises which you can learn to do on your own. Nerve and tendon gliding exercises have been shown to be helpful in carpal tunnel syndrome. Simple exercises I have found helpful are stretches which involve the fingers and wrist, pulling them back into extension and holding the stretch for 20 seconds, then relaxing. This can be repeated for up to 5 minutes per session, 2-3 times per day. This stretch shouldn’t be painful or done with excessive force. Therapists can also do therapeutic ultrasound and iontophoresis treatments which can help reduce symptoms.
Physical activity and exercise
Several studies have shown a reduction in carpal tunnel symptoms when patients were involved in an exercise program, particularly vigorous physical activity. Jogging, swimming, playing sports, biking, even walking around the neighborhood are all physical activities which are good for you, and your carpal tunnel!
Weight loss
Obesity and high body mass index (BMI) have been shown to be strong risk factors for carpal tunnel syndrome. Weight loss might reduce this risk. This is obviously easier said than done.
Vitamin B6 supplements
Using Vitamin B6 supplements for CTS is controversial. Some studies support the use, and some studies do not. Vitamin B6 is involved in several metabolic pathways in nerve function, and patients with an undiagnosed vitamin deficiency can develop neurologic symptoms as a result. It would make sense that taking a supplement for those patients would be beneficial. For the average person however, it is not clear. Some studies have shown that taking 100 mg of Vitamin B6 every day for 12 weeks is safe and helpful for patients with CTS. I would discourage anyone from taking much higher doses of Vitamin B6, as this can cause toxicity. Some “health experts” online encourage patients to take very high doses of vitamins for CTS, which is not a good idea.
Reduce or quit tobacco use
Nicotine is an addictive chemical in tobacco products. It also constricts arteries and reduces blood flow in the body. If the blood flow in the hand is reduced, the nerves can be more sensitive to injury. Stopping tobacco use may reduce the risk of CTS symptoms.
Modifying your hand/wrist activities
Pressure on the nerve within the carpal tunnel is increased with forceful gripping tasks. It would make sense to take rest breaks and do stretches when you need to use the hands for heavy gripping. For example, when I am in heavy traffic and “white knuckle” gripping the steering wheel, my hands will go numb. A lighter grip on the wheel will help this calm down. Using vibrating power tools in the yard, such as a hedge trimmer or edger, can also flare up CTS symptoms. Gardening has also been shown in studies to contribute to CTS symptoms. Motorcycle riders often get CTS symptoms because they are forcibly gripping the handlebars and getting hand vibration from the ride. Common sense tells us to be careful with these activities and adjust how the hand is used when possible.
Take care with computer work
Whether or not computer work increases the risk of carpal tunnel syndrome is controversial. Some studies suggest that prolonged computer work can contribute to carpal tunnel syndrome, other studies do not show this risk. I suspect that it is not the computer itself that is the culprit, but the way we use it. If someone has poor posture at their desk and types with the wrists bent for a prolonged period of time, there can be increased pressure on the nerves. I would suggest taking rest breaks, stretching, and maintaining good posture of the neck, back, shoulders and wrists to avoid CTS symptoms.
Consider steroid injections
Corticosteroid injections are commonly used in the office of orthopedists and hand specialists. These are often called “cortisone shots.” Corticosteroids are steroid hormones produced in the body. They have many different natural functions, one of which is regulation of inflammation through the immune system. Scientists have discovered the chemical structures of corticosteroids, which allow them to create these molecules in the lab to be used for medical purposes. Physicians often use these medications to reduce inflammation in the body. If used carefully and sparingly, steroid injections are safe and have few side effects. Most patients obtain at least temporary relief from CTS symptoms from an injection. Symptom relief is about 3-6 months on average. Approximately 1/3 of patients can have long-term resolution of symptoms from a single injection, and these patients do not require surgery. I typically recommend trying a steroid injection in patients with mild to moderate CTS prior to considering surgery.
Take caution with use of NSAIDs
Non-steroidal anti-inflammatory drugs (NSAIDs) are oral medications used to reduce pain and inflammation. Examples are ibuprofen and naproxen, which can be purchased over-the-counter. Some patients can have short-term relief of CTS symptoms with these medications. However, most research studies do not recommend using NSAIDs for CTS treatment, especially long-term. Use of NSAIDs is associated with increased risk of gastrointestinal bleeding, kidney disease, and heart attack. These risks increase in patients with certain medical problems and when used long-term or at higher doses.
Be skeptical of online “experts”
Finally, beware of cure-all treatments you may find online. If something sounds too good to be true, it probably is. And if someone is trying to sell you something with a money-back guarantee and 100% successful results, think twice before buying. If you need carpal tunnel surgery, don’t be afraid to consult with a hand specialist who is an expert in treatment.