Carpal tunnel syndrome therapy is started immediately after the diagnosis. A delay would mean exposing the nerve to further damage, which could aggravate the symptoms and sequelae. There are several treatment options for carpal tunnel syndrome: Therapy using conservative methods or surgery. Read here, which therapy is used in which cases and what happens there.
Carpal tunnel syndrome: therapy after stage
Basically, there are different ways to treat a carpal tunnel syndrome. Depending on the severity of the disease and the symptoms that occur, two therapeutic methods are used:
- Conservative carpal tunnel syndrome therapy
- Operative carpal tunnel syndrome therapy
Your doctor will work with you to choose the best therapy option for you. The decisive factor is the stage of the disease: In mild to moderate cases, attempts are initially made to relieve the symptoms with conservative therapy. If this is not possible or if the symptoms represent a significant impairment of the everyday life of the person concerned, the operative therapy is recommended.
Carpal tunnel syndrome therapy: conservative methods
Conservative means as much as preserving in medicine. In the present case, this means a carpal tunnel syndrome treatment without surgical intervention. Because an operation is always associated with certain risks.
When is a conservative carpal tunnel syndrome therapy performed?
A maintenance carpal tunnel syndrome therapy is indicated in all mild to moderate disease cases. This means that the pain is classified by the sufferer as stressful, but not as completely restrictive in everyday life.
In general, conservative treatment is also used in young people, pregnant women, and people who have carpal tunnel syndrome underlying a treatable condition (such as diabetes).
What conservative methods are there?
The symptoms of carpal tunnel syndrome can be alleviated by:
- Nocturnal immobilisation of the wrist: With a special splint, the wrist is fixed in the middle position at night. During the day, the carpal tunnel syndrome splint, which is usually provided with Velcro, can be easily removed.
- Cortisone: In certain cases it may be necessary to inject a cortisone preparation into the wrist or to take cortisone tablets. The injection is not without risk, as the puncture could damage the tendons and nerves.
If the carpal tunnel syndrome has been triggered by an excessive load, the hand must be spared to avoid further overuse. For persistent complaints in the exercise of your profession, you should consider changing the profession.
Other conservative methods of carpal tunnel syndrome therapy that have been tried in the past, such as laser, yoga or ultrasound, are not effective.
Carpal tunnel syndrome therapy: surgery
In many cases, those affected come to the doctor very late. The nerve is then usually damaged so far that a conservative therapy is no longer sufficient. An operation is therefore useful for the following diagnoses:
- Failure of conservative carpal tunnel syndrome therapy after eight weeks
- Strong nocturnal pain
- Persistent numbness
- Greatly reduced values in the measurement of nerve conduction velocity
Carpal tunnel syndrome surgery is performed by a hand or neurosurgeon under local anesthesia. It is usually done on an outpatient basis. After the operation, the wrist is immobilized for a few days with a wrist splint. Surgery can be performed without hesitation, even if the patient is of high age and during pregnancy.
In the past, two surgical procedures have been established:
1. Open carpal tunnel syndrome operation
In open carpal tunnel syndrome surgery, the band, which is located above the bone gland on the wrist (palpation band), severed by the surgeon. In addition, tissue that restricts the nerve is removed. As a result, the nerve and tendons have more space again. The cut in the operation runs along the longitudinal line of the palm, so it is hardly noticeable afterwards.
An open surgery is performed if the anatomy of the wrist in the patient deviates from the norm, the mobility of the wrist is limited or it is a repeated operation (recurrence).
2. Endoscopic carpal tunnel syndrome therapy
During endoscopic surgery (including keyhole surgery), the surgeon inserts the entire instrument over an approximately one to two centimeters long skin incision across the flexion fold of the wrist. The actual operation then proceeds as with the open surgery.
Both surgeries are equivalent in their outcome, but endoscopic surgery often reloads the wrist earlier. For the conventional open carpal tunnel syndrome therapy is cheaper.
What happens after a carpal tunnel syndrome operation?
After surgery, you first get a cast splint to keep the wrist quiet. For one day, the affected arm must be kept completely still, but one day after the operation you should start with simple finger exercises to promote mobility and healing. To avoid swelling, the arm should be stored high. In the first few days, you can alleviate any pain with the help of painkillers and cold packs.
After eleven days, the threads are removed over the surgical scar. During this time you should not lift anything heavy and support yourself with the hand in question. For showering, you should wrap your hand in a plastic bag as the dressings and threads should not get wet.
The scar can be treated with a commercial fatty ointment, a special scar cream is not necessary.
The duration of incapacity to work depends on the extent to which the hand is charged at work. As a rule, you are not allowed to work or exercise for three to four weeks after an operation. With a low load on the wrist in the job the Einstig is also possible earlier again, with a heavy load often only later. Clarify this with your doctor.
How To Support Carpal Tunnel Syndrome Therapy
In an advanced carpal tunnel syndrome, you can do very little yourself, because a changed hand position or a reduced load on the hand, although the symptoms alleviate, but not correct the cause. An operation is then in many cases the only way to give you a trouble-free life again. However, after the carpal tunnel syndrome surgery, there are some advices you should follow to support the success of therapy:
Be sure to follow the surgeon’s advice after carpal tunnel syndrome surgery. It is important that you begin with finger exercises immediately, even if it hurts at the beginning, to maintain flexibility and promote healing. In the carpal tunnel syndrome, there are also exercises for the wrist that provide relief and promote mobility. For example, at home, you can stretch your arms straight and bend your hands 90 degrees backwards toward your face. This is how you stretch your arms and wrist and promote a healthy carpal tunnel syndrome healing process. Physiotherapy and exercises should be performed for several weeks after carpal tunnel syndrome treatment.
An upright posture is also important in carpal tunnel syndrome.
Post-surgical pain and swelling conditions are usually due to too tight bandages, insufficient finger movements or excessive hand restraint, and should not be confused with complications caused by surgery.
Splint and restraint should be discarded after one to three weeks. Then you should try to use your wrist as before the operation.
Lasting insensitivity
Complications of carpal tunnel syndrome therapy
The regression of numbness may take several weeks. Especially in severe cases, in which the insensitivity was pronounced, the regression may extend over several months. If six months after carpal tunnel syndrome therapy, there is still no improvement, you should make an appointment with the neurologist again. Sometimes this persistent numbness can be remedied by a (re) surgical procedure. In severe cases – especially if the surgery is too late – insensibility can persist for a lifetime.
In general, both surgical methods for carpal tunnel syndrome are considered very low in risk. The usual symptoms of surgery, such as secondary bleeding, infection or swelling rarely occur. However, there may be other complications depending on the surgical technique.
Risks of open carpal tunnel syndrome surgery
During open surgery, the nerve or its branches may be damaged during surgery. As a result, feelings of weakness in the area of the fingers and the ball of the thumb are possible. In extreme exceptional cases, it comes to a lengthy, sometimes very painful bone decalcification and soft tissue swelling, which may also result in joint stiffness (Sudeck’s disease).
The scar may be painful for several weeks after surgery and may be sensitive to touch or strain.
Risks associated with endoscopic carpal tunnel syndrome surgery
In endoscopic carpal tunnel syndrome therapy, the risk of nerve injury is greater because the surgeon can not fully understand the anatomy and any special features in the wrist. Occasionally, the operation must be repeated again if the carpal ligament has not been completely severed. The scar problems are less.
Sometimes, during surgery, bleeding or unexpected wrist anatomy transforms endoscopic surgery into open surgery.
The “Schnappfinger”
After both surgical procedures, it can happen that a single finger snaps or hurts badly. Then the tendon sheath was injured or pinched. This “snap finger” can be treated by a surgery with local anesthesia. It comes to a snap finger in about 20 percent of all cases, so it is the most common complication in carpal tunnel syndrome therapy.
Carpal tunnel syndrome: homeopathy
Homeopathic applications (such as ointments) in the carpal tunnel syndrome are advertised by many information sites on the Internet. Their effectiveness in the Carpal Tunnel Syndrome Therapy However, it is not scientifically proven.