DEAR DOCTOR K:
I have carpal tunnel syndrome. How can I relieve the discomfort without drugs or surgery?
Carpal tunnel syndrome causes pain and discomfort in the wrist that can extend into the hand or forearm. It’s often caused by activities that require constant use of the wrists. People who spend a lot of time at a computer keyboard, for example, pounding away at the keys, are more likely to experience it.
Carpal tunnel syndrome results from compression of the median nerve. This is a major nerve that extends from the spinal cord through the wrist and to the fingers. In the wrist, the median nerve passes through a narrow channel called the carpal tunnel.
The carpal tunnel is made of stiff fibers and is only slightly wider than the median nerve. As a result, if repeated activity of the wrist leads to inflammation and swelling of the tissue in the wrist, the nerve can become pinched and compressed, see below for an illustration of this:
Nerve Compression in Carpal Tunnel Syndrome
Carpal tunnel syndrome initially causes tingling, numbness and burning pain in the wrist. These symptoms are also felt in the thumb and second and third fingers, because that’s where the nerve fibers lead.
Sleeping with your wrists in a flexed position can worsen pressure on the nerve. That’s because when the wrist is flexed, the nerve is more easily pinched inside the carpal tunnel. You may awaken with tingling and achiness in the wrist.
As the condition progresses, the muscles in the hand can begin to waste away and the nerve can become permanently damaged. This can lead to weakness and loss of function and sensation, as well as pain.
So don’t treat possible symptoms of carpal tunnel syndrome as just an annoyance: Let your doctor know about them. Non-drug and non-surgical treatments are most effective if used when symptoms first begin, before the nerve is damaged.
The first step is typically a splint that keeps the wrist in an open (unbent) position. This helps prevent compression of the median nerve, and can relieve mild to moderate discomfort and disability.
Wear the splint while sleeping. If you have constant pain, wear the splint during the day for four to six weeks, then decrease use of it over the next month. Because you’re trying to avoid drugs and surgery, you may even benefit from wearing a splint intermittently for years.
You can also work with an occupational therapist (OT), who can teach you to use your hands in ways that will not aggravate your condition. An OT can also recommend adaptive equipment, such as gripping devices, or an ergonomically designed keyboard to use at home or at your office.
These non-surgical approaches usually provide relief. If they don’t, injections of inflammation-calming medicine into the carpal tunnel may help. If surgery is required, it’s pretty simple — not a major operation. But non-surgical measures often are sufficient to fix the problem.