Treatment and Prognosis of carpal tunnel syndrome(CTS)

Carpal tunnel syndrome (CTS) – treatment + prognosis:

Treatment of CTS depends on the severity of the symptoms and the underlying cause. Initial treatment involves rest, immobilising the wrist using a splint (holds wrist in dorsiflexion over night), avoiding activities that worsen the symptoms, and if inflammation is there using an ice pack can help reduce swelling. We can basically divide treatment into 2 categories; non-surgical and surgical.

Non surgical treatment

  • · Drugs: help ease pain and swelling associated with CTS. Non steroidal anti-inflammatory drugs (NSAIDS) such as aspirin help relieve pain if there are associated inflammatory conditions/processes. They help with symptoms that have been present for a short time or caused by strenuous activity. NSAIDS are unlikely to relieve symptoms if inflammatory conditions are unlikely. Corticosteroids (e.g. lidocaine, prednisone) can also be used, they are either injected directly into the wrist or taken orally help relieve pressure (decrease inflammation) on the median nerve and provide immediate temporary relief for people with mild or intermittent symptoms (people with diabetes should note that prolonged using of corticosteroids can make it difficult to regulate insulin levels). Vitamin B6 (pyridoxine) has been shown to relieve symptoms; the mechanism of how it works is unknown.
  • · Alternative therapies: yoga and other relaxation techniques help. Yoga postures designed for strengthening, stretching and balancing each joint in the upper body, helps reduce pain and improve grip strength for CPS patients. Others include special physical therapies: heat, massage, chiropractic manipulation, osteopathic manipulation, acupuncture, water therapy.
  • · Wrist splinting at night as mentioned helps, and can be used as a treatment for mild CPS. For CPS patients whose symptoms have abated stretching and strengthening exercises can help, and can be supervised by a physical therapist.

Surgical treatment

Persistent symptoms (6 months) or nerve damage requires surgical decompression of the carpal tunnel. The surgery is called “carpal tunnel release”, and can be done under general or local anaesthetic, and is an outpatient procedure. Surgery basically involves cutting the flexor retinaculum (completely or partially) around the wrist, which reduces the pressure on the median nerve. The following are types of carpal release surgery:

  • · Open release surgery – the traditional procedure. Consists of making an incision of up to 2 inches in the wrist and cutting the retinaculum.
  • · Endoscopic surgery – surgeon makes 2 incisions (about ½ inches each), in the wrist and palm, inserts a camera attached to a tube, and observes the tissue on a screen, cuts the ligament. This is much more effective and minimises scarring and scar tenderness, allows for faster functional recovery and less post operative discomfort than the open release surgery. One portal endoscopic surgery is also available.

Incisions are made towards the medial side of the wrist and flexor retinaculum to avoid possible damage to the recurrent branch of the median nerve which supplies the thenar muscles. After surgery hand is elevated above heart level (reduce swelling) and bandaged.

Surgery results in immediate marked improvement of symptoms, and is very effective. Full recovery can takes several weeks or months. Occasionally the wrist loses strength because the retinaculum (ligament) is cut, physical therapy after surgery helps restore wrist strength. The operation is generally safe, and complications are unlikely but possible, they include those related to anaesthesia and those related to any type of surgery (infection, bleeding, scarring), and those specifically to this surgery (nerve injury – resulting in numbness, pain, weakness, paralysis, of the hand and tendon injury – weakness of hand).

Prognosis:

If left untreated, damage to the median nerve persists, and can result in sensory loss of the palm and radial 3½ fingers, muscle atrophy, wasting of abductor pollicis brevis and eventually paralysis of the hand/area supplied by the median nerve.

Sources:

http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm

http://www.mayoclinic.com/health/carpal-tunnel-syndrome/DS00326/DSECTION=treatments-and-drugs

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~ by pcl4 on September 1, 2008.

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