About carpal tunnel syndrome

Carpal tunnel syndrome develops when a large nerve – the median nerve – is compressed inside your wrist. This nerve controls feeling in your thumb, index finger and thumb side of the ring finger. The median nerve also controls the muscles at the base of your thumb. The condition gets its name from the eight carpal bones that surround the median nerve in your wrist, forming a tunnel to your hand.

The tunnel is just big enough for the median nerve and several tendons to run through it. Anything that makes the tunnel smaller (such as arthritis) or makes the tendons larger (such as thickening of the tendon linings) can cut off the circulation to the nerve. When this happens, you notice pain, numbness and tingling in your fingers.
Causes of carpal tunnel syndrome
Pressure on the median nerve can be caused by:

• A wrist injury or a fracture of the wrist or the end of the forearm
• Frequent use of vibrating hand tools
• Any repetitive, forceful motion with the wrist bent, especially when done for prolonged periods without rest

Carpal tunnel syndrome can also be caused by underlying medical conditions including:

• Rheumatoid arthritis
• Osteoarthritis
• Hypothyroidism and, less often, hyperthyroidism
• Diabetes
• Pregnancy
• Amyloidosis
• Acromegaly
• Systemic lupus erythematosus

Symptoms of carpal tunnel syndrome usually improve or go away when these underlying medical conditions are treated – or in the case of pregnancy, after the baby is born.

In many cases, the syndrome has no specific cause – in spite of the widespread belief that everyone in the work force is at risk. Jobs that require you to grip something repeatedly and forcefully or hold your fingers or wrists in an abnormal position may contribute to the condition in some people, but studies seeking to find a cause-and-effect relationship are inconclusive.

One clear finding from these studies is that frequent computer use doesn’t cause carpal tunnel syndrome, though it may worsen your symptoms. Several studies have found no relationship between computer use of up to seven hours a day and risk of carpal tunnel syndrome.
What increases your risk?

• Being female and middle-aged. Women are three times as likely as men to develop carpal tunnel syndrome. Doctors aren’t sure why. Fluid retention caused by hormone shifts may be a factor, as may having large breasts. So might the fact that women’s carpal tunnels are smaller than men’s.
• Obesity. Obesity increases your risk of carpal tunnel syndrome. Numerous studies have found more than twice as many carpal tunnel syndrome cases among the obese as among those with average weights.
• Genetics. Your genetic makeup may increase your risk of carpal tunnel syndrome. Researchers have found that in fraternal twins, the chance that both twins will develop carpal tunnel syndrome is significantly lower than that in identical twins, who share all the same genes. One specific – but rare – hereditary nerve disorder seems to cause carpal tunnel syndrome in a small number of people.
• Smoking. People who smoke cigarettes may experience worse symptoms and slower recovery from carpal tunnel syndrome than nonsmokers do.

How common is carpal tunnel syndrome?
Carpal tunnel syndrome affects about three out of every 100 people in the United States, although some estimates place the number higher. It is one of the most common causes of partial disability – both temporary and permanent. Slightly more than half of those who miss work because of carpal tunnel syndrome miss 31 days in one year. Up to 50 percent of people who have carpal tunnel syndrome have it in both hands.

Left untreated, carpal tunnel syndrome can lead to irreversible nerve and muscle damage. Fortunately, permanent nerve damage usually can be avoided if you’re diagnosed and treated early. Among people with a clear diagnosis of carpal tunnel syndrome, treatment relieves most of the pain, tingling and numbness. On the other hand, many people treated for carpal tunnel syndrome report persistent problems, and a few say their hands never get back to normal.
Symptoms of carpal tunnel syndrome
Carpal tunnel syndrome usually develops gradually. Pressure on the median nerve produces a specific pattern of numbness, tingling and pain that usually is worse at night. As the condition worsens, you may lose some hand strength and dexterity. You may experience any or all of these symptoms:

• Numbness, burning, tingling or pain in the hand or fingers – but not in the little finger
• Increased discomfort at night or first thing in the morning
• Increased discomfort with prolonged grasping or flexing of the wrist
• Temporary symptom relief when you “shake out” your hands
• Hand weakness, especially loss of pinch strength or difficulty holding and picking up objects
• Loss of feeling in your thumb, index and middle fingers, and the thumb side of your ring finger
• Shrinkage or weakness of the muscle at the base of your thumb
• Inability to distinguish temperature changes

Diagnosing carpal tunnel syndrome
No single test can tell for sure if you have carpal tunnel syndrome. Instead, your doctor reviews your medical history and does a physical exam, then may arrange for you to have one or more tests.

During a physical exam for suspected carpal tunnel syndrome, your doctor examines your hands, arms, shoulders and neck. Your doctor may also:

• Show you a hand diagram and ask you to mark those places where you experience numbness and tingling. One clue that it might be carpal tunnel syndrome is if you don’t have symptoms in your little finger. That’s because the median nerve doesn’t provide sensation to it. Hand diagrams are one of the most helpful diagnostic tools doctors use.
• Examine muscles at the base of your thumb for signs of shrinking (atrophy).
• Check to see how sensitive to touch your index finger is compared with your little finger.
• Check your ability to feel vibrations or mildly painful sensations on your fingers. Diminished ability to feel these sensations (hypalgesia) may suggest that you have carpal tunnel syndrome.

Common diagnostic tests
During your exam, your doctor may give you the following tests to help diagnose carpal tunnel syndrome:

Phalen’s test. In this test, you place your elbows on the table with arms up. Bend your wrists down as far as you can while pressing the backs of your hands together for 30 to 60 seconds. If you feel tingling or numbness, it may mean that you have carpal tunnel syndrome.

Tinel’s test. Your doctor taps on the median nerve at your wrist. If you feel tingling or a shock-like sensation in the fingers served by the median nerve, you may have carpal tunnel syndrome.

Compression test. For this test, your doctor will apply constant pressure to the median nerve for 30 seconds. If you feel tingling or numbness, you may have carpal tunnel syndrome.
Additional tests
None of the tests above is completely accurate, possibly leading to an incorrect diagnosis – positive or negative. A physical exam doesn’t always provide the answer either. That’s why your doctor may order these additional tests:

X-rays. These help rule out arthritis, bone spurs, fractures, tumors, cysts and gout.

Nerve tests. These tests help measure how well your median nerve is working. Nerve tests are the most reliable tests for confirming if you have carpal tunnel syndrome. Two types of nerve studies are routinely used to diagnose carpal tunnel syndrome.

• Electromyograms (EMGs). EMGs measure the tiny electrical discharges produced in muscles. A thin-needle electrode is inserted into the muscle or muscles your doctor wants to examine. An instrument records the electrical activity in your muscle at rest and as you contract the muscle. The test can help determine if you have nerve damage in your hand caused by long-term pressure on the median nerve.
• Nerve conduction studies. These are the most sensitive tests for confirming if you have carpal tunnel syndrome. They measure the speed at which electrical impulses travel along your nerves. Electrodes are taped to your fingers and arm. A mild shock passes from one electrode to the other through your median nerve. If the electrical impulses slow down in the carpal tunnel, this is the strongest evidence that you have carpal tunnel syndrome.

Diagnostic ultrasound. Ultrasound is a new and alternative way to help determine if you have carpal tunnel syndrome. Its use for this purpose is still being studied and may not be available in your area. Sound waves are bounced off your hand and wrist to create images of nerves, muscles and tendons. Carpal tunnel syndrome can make the median nerve look thinner than normal. Ultrasound can’t test nerve function, though, so it can only suggest a diagnosis.
Treatment options
All traditional treatments for carpal tunnel syndrome attempt to relieve pressure on the median nerve as it passes through the carpal tunnel in your wrist. Which treatment choice you make depends on the following:

• How severe your symptoms are
• What’s causing your symptoms
• How long you’ve had them

Treatments for carpal tunnel syndrome fall into two general categories: surgical and nonsurgical. Both have potential risks and benefits.
Nonsurgical
Nonsurgical treatments include a sequence of options, starting with simple steps you can take, such as activity modification, and moving on to more involved treatments, such as splints and corticosteroid injections.

Most people with carpal tunnel syndrome should at least give nonsurgical treatments a try. These treatments work best if you haven’t lost any hand strength. They might work – saving you the cost of surgery and the discomfort and time away from work that follows surgery. If they don’t work, you’ll know in a few weeks, and you can then have surgery.
Activity modification
Wrist position is key to controlling your carpal tunnel syndrome symptoms. The carpal tunnel is most narrow when your wrist is either bent down or cocked back all the way. It is largest when the wrist is straight. For this reason, changing how you do repetitive hand activities or avoiding those activities altogether can help. The more your wrist is bent, the more pressure is put on your median nerve. To protect your hands, take these precautions:

• Take breaks. When doing activities that require repetitive, forceful motion with your wrists bent, stop every 15 to 20 minutes and gently stretch and bend your hands and fingers. When working with vibrating equipment, wear gel-padded gloves. These absorb vibration that can cause swelling around the median nerve. If possible, change activities for several minutes every hour.

Most important, rethink what you’re doing. Often, it’s possible to do the same task and avoid extreme wrist positions, simply by changing your position or that of the object you’re working on. Or, you can modify the grip or handle of your tools, for example, going from a straight handle to a pistol grip.

• Relax your grip. Avoid gripping too hard when driving, writing or using hand tools. Most people use more force than necessary when doing hand tasks. When working on a computer, for example, tap the keys softly. When writing, use a thick pen with an oversized, soft grip adapter and free-flowing ink. That way you won’t have to grip the pen tightly or press as hard on the paper.
• Use proper posture. Poor posture causes your shoulders to roll forward, shortening your neck and shoulder muscles and compressing nerves in your neck. This can affect your wrists, fingers and hands because some nerves in the upper body eventually connect to the median nerve. When compressed, they affect how they send signals to and from your hand.
• Reduce wrist bending. Avoid bending your wrist all the way up or down. A relaxed middle position is best. Keep your computer keyboard at elbow height or slightly lower. A keyboard wrist pad placed in front of the keyboard further relieves wrist strain. However, resting with too much pressure on the wrist pad or on a hard surface may exacerbate symptoms.
• Keep your hands warm. Pain and stiffness are more likely to occur if your hands are cold. Adjust the room temperature or wear fingerless gloves.

Splinting
Splints (braces) are the most commonly used nonsurgical treatment for carpal tunnel syndrome. Splints that immobilize the wrist in a neutral (unbent) position are most likely to relieve discomfort. An unbent wrist maximizes the size of the carpal tunnel, which reduces pressure on the median nerve, relieving your symptoms.

You can buy ready-made splints at a medical-supplies store. Or you can ask your doctor to have custom-made splints made for you. Both are equally effective, although many people find custom-made splints more comfortable to wear. In either case, you may find splints make certain hand movements difficult to do.

You may need to wear a splint for a few days to a week or more before noticing significant improvement. Some studies show that continuous splinting – wearing a splint both day and night – is more effective than wearing it just at night. Others, however, show little or no added benefit from 24-hour splinting, particularly in terms of symptom relief. Also, many people find that a splint restricts their hand and wrist movements too much to be worthwhile at work and around the house, so night wear alone is a good option.

Splints are safe, relatively inexpensive and give many people with carpal tunnel syndrome excellent short-term relief from their symptoms. Besides relieving discomfort, splints can sometimes improve conduction of nerve impulses along the median nerve, which can improve strength, dexterity and sensation.

Splints are most likely to work for you if you’ve had mild to moderate carpal tunnel syndrome symptoms for one year or less. Splints may be a good choice if pregnancy is causing temporary discomfort you can’t tolerate.
Physical therapy and exercise
Sometimes, physical therapy or special hand exercises relieve mild to moderate symptoms of carpal tunnel syndrome.

Gliding exercises. Some people who don’t get adequate relief from splints and activity modification do get more relief when these treatmentsare combined with nerve and tendon gliding exercises. Gliding exercises alone may help, but usually not as much as when they’re combined with other treatments.

• Tendon gliding exercises. You move your fingers through five positions with your wrist in a neutral (unbent) position.
• Median nerve gliding exercises. You move your hand through six positions while your wrist is in a neutral position.

During both types of gliding exercises, you maintain each position for seven seconds. Repeat each set of exercises five times, three to five times each day.

Gliding exercises relieve pressure on the median nerve. During the exercises, your median nerve is exposed to a higher pressure, followed by a lower pressure. The pressure changes are believed to shift the point on the median nerve that’s under the most pressure as it passes through the carpal tunnel. The exercises may also loosen and stretch the carpal ligaments, further easing pressure. Gliding exercises may also encourage movement of blood out of the carpal tunnel, further relieving fluid pressure on the nerve. Similarly, the exercises may help reduce water retention in the carpal tunnel.

Contrast baths. These baths can help reduce carpal tunnel swelling. To do this therapy, soak your hand in warm water for five to 10 minutes, then in cold water for one minute, then back and forth between hot and cold. You typically do this twice each day. Contrast baths are often done in combination with gliding exercises to relieve symptoms.

Ultrasound. Directing ultrasound waves at the carpal tunnel can be helpful in mild to moderate carpal tunnel syndrome, though results have been mixed. In one study, 20 sessions of therapy during seven weeks significantly relieved discomfort and improved hand function after two weeks, seven weeks and six months. Other studies have shown no benefit.

Exercises and physical therapy don’t change the natural course of carpal tunnel syndrome, which tends to worsen over time. These treatments are typically most effective in temporarily relieving symptoms of mild to moderate carpal tunnel syndrome. Keep in mind, though, if you change how you do routine activities and treat any underlying medical condition that might be worsening your carpal tunnel syndrome, you may notice permanent improvement.
Drug therapy
Drug treatment of carpal tunnel syndrome attempts to reduce any inflammation in the carpal tunnel that might put pressure on the median nerve. These medications are commonly used:

NSAIDs. If tendinitis or another inflammatory condition accompanies your carpal tunnel syndrome, you can relieve some of the pain by taking nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs include ibuprofen (Advil, Motrin, others), naproxen sodium (Anaprox, Aleve, others) and aspirin – either prescription or over-the-counter.

NSAIDs are unlikely to relieve your symptoms if inflammation isn’t causing your discomfort – and most people don’t have inflammation around their nerve. NSAIDs do nothing to relieve other carpal tunnel syndrome signs and symptoms, such as tingling, numbness or hand weakness. Even when an inflammatory condition is present, NSAIDs may be most effective when used in combination with splinting, activity modification and gliding exercises. When used in such combination, it’s difficult to know if the NSAIDs are adding to the known benefit of those other treatments. Even nonprescription NSAIDs may cause side effects in some people if taken for a long time. Consult your doctor before taking NSAIDs.

Diuretics. Diuretics are high blood pressure medications sometimes prescribed on the theory that fluid retention in the carpal tunnel can cause pressure on the median nerve. There’s no evidence this is true. Diuretics have undesirable side effects and are rarely used.

Corticosteroids. If you don’t get adequate relief from splints or activity modification, your doctor may inject your carpal tunnel with a corticosteroid, such as cortisone. Corticosteroid injections can be quite effective in providing temporary relief from carpal tunnel syndrome symptoms. The main effect of these drugs is to reduce inflammation, whether it’s from arthritis, asthma or some other condition. Because surgery for carpal tunnel syndrome rarely reveals any evidence of inflammation, though, the reasons for corticosteroids’ effectiveness in carpal tunnel syndrome are unknown. Corticosteroid pills don’t work as well as corticosteroid injections.

Corticosteroid injections will most likely give you long-term relief from carpal tunnel syndrome symptoms if you:

• Have mild to moderate symptoms for one year or less
• Have no loss of feeling or strength in your hand

Corticosteroid injections may provide significant short-term relief from pain, tingling and numbness. Often, some relief is immediate. Relief then builds over time, often peaking about one month after injection. The length of time an injection is effective varies greatly from several weeks to more than a year. Relief may last longer if your carpal tunnel syndrome symptoms are mild to moderate at the time of injection.

You may get renewed relief from a second injection. However, some trials have found that fewer than half of those who got good relief from the first injection got adequate relief from the second.

Complications with corticosteroid injections are rare. However, the risk of complications increases as you have more injections. These rare complications include nerve injury and tendon rupture.
Pros and cons
For most people with carpal tunnel syndrome, doctors try nonsurgical treatments before opting for surgery. However, the decision is a personal one influenced by the cause and severity of your symptoms and your feelings about surgery. When deciding whether to try nonsurgical options or skip them, keep these points in mind:
Pros
Nonsurgical techniques are less invasive than surgery, which means you don’t have lost workdays or time away from routine activities. You also don’t face the rare, but possible, risks of surgery, such as infection, nerve damage or a bad reaction to the anesthetic.

Most people get at least short-term relief from one or a combination of nonsurgical treatments. Many get long-term relief.

You can try nonsurgical options first without exposing yourself needlessly to surgery. Then you can have surgery if the nonsurgical treatments don’t work.
Cons
Nonsurgical techniques are usually effective only in cases of mild to moderate carpal tunnel syndrome.

They’re less likely than surgery to provide permanent symptom relief. They may provide only temporary relief to a long-term problem that may worsen without surgery.

Nonsurgical treatments may lead you to postpone an operation you’ll eventually have to get. If you wait too long to decide on surgery, you may reduce your chance of a completely successful operation.
Surgical
Carpal tunnel surgery cuts the transverse carpal ligament. Cutting the ligament is like cutting a rubber band wrapped over a rolled-up newspaper. It allows the carpal tunnel to expand in size, relieving pressure on the median nerve and thereby reducing or eliminating carpal tunnel syndrome symptoms.

Carpal tunnel surgery is usually done by an orthopedic surgeon, a plastic surgeon, a hand surgeon or a neurosurgeon. Two types of carpal tunnel surgery are widely available: open carpal tunnel release (OCTR) and endoscopic carpal tunnel release (ECTR). Both surgeries are commonly performed in the United States.
Open-release surgery
Open carpal tunnel release (OCTR) surgery can be done as an outpatient procedure in a hospital or surgical center operating room. If you have carpal tunnel syndrome in both hands, you can have surgery done on both hands at once, or you can have the second hand done as soon as a few weeks after the first surgery, depending on how the first hand is feeling.
How is it done?
OCTR is performed under local anesthesia. The anesthetic, which is injected into the palm, causes burning that many people consider the most painful part of the operation. This burning can be significantly reduced if the surgeon mixes some sodium bicarbonate with the anesthetic. Your doctor makes a small incision in the base of the palm and sometimes extending into the wrist, measuring about 1 to 2 inches (about 2 to 5 centimeters) in length. This opens the skin so that your surgeon can see the ligament as it’s cut with a sterile surgical blade. The cut ligament springs open and immediately provides more space for the median nerve to pass through the carpal tunnel. The skin incision is then closed with stitches (sutures). Complications include nerve injury and infection, but these rarely happen – infection occurs in about one in 100 people, and accidental nerve injury in fewer than one in 1000.
After the procedure
Your hand, wrist and forearm are wrapped in a bulky dressing. You can still move your fingers and thumb, but your wrist is confined to prevent you from bending it. You can usually go home in an hour or two, but don’t drive the rest of the day. Most people require only a few prescription pain pills for a day or two after surgery. After that, you can use over-the-counter pain pills such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin, others) or naproxen sodium (Aleve, others).

A few days after surgery, your doctor removes the bandages and examines the surgical site. Your incision is covered with an antibiotic ointmentand a light sterile gauze bandage. You’re fitted with a splint that goes around your hand and wrist. It’s important to remove the splint several times each day and gently exercise your wrist by bending it up and down. It’s also important that you use your fingers and thumb to do light activities such as dressing and eating.
Recovery
Keep the incision clean and dry. It’s usually OK to change the bandage and clean the incision area if the bandage gets dirty, but check with your doctor to be sure.

• First two weeks. During the first two weeks after surgery, don’t lift objects weighing more than a pound or so. A cup of coffee is OK; a gallon of milk is not. Usually, you can remove the splint while doing light activities, such as eating, dressing and driving. Your sutures typically are removed about two weeks after surgery. By then, you’ll probably feel little or no discomfort at rest, although scar tenderness and pain with heavier activities are normal and can persist for several months. After the sutures are removed, apply a moisturizing lotion to the incision. This helps soften and desensitize the scar tissue forming where the incision was made.
• Four weeks and later. About four weeks after surgery, you can do heavier tasks such as vacuuming, mowing, gardening and most sports activities. Carpal tunnel surgery usually relieves nighttime pain and tingling quickly and fairly well. Numbness may take longer to go away. Maximum return of feeling to your fingers may take three to six months, depending on how severely your median nerve was compressed. If your initial numbness was severe, some permanent numbness may persist.

Your palm may feel tender for several weeks after surgery. This should go away in time. Up to a year may pass before your normal hand strength returns. It’s not unusual for some symptoms to persist. Only about half the people who have carpal tunnel surgery feel normal afterward, although nearly all are happy with the amount of symptom relief they’ve gotten. While some symptoms may persist, those that have gotten better usually don’t come back. It’s unusual for carpal tunnel syndrome to recur to a degree that requires a second operation after open release.

When you can return to work or school varies greatly. If your nondominant hand was operated on and you have a desk job with flexible hours, you could return to work a day or two after surgery. If your dominant hand was operated on, you do heavy, repetitive work and no job modifications are available, it could be six to eight weeks before you return to work.

The advantage of having both hands operated on at once is that you have to go through recovery only once. The disadvantage is that during recovery you’ll have limited use of both hands, which can make daily activities and self-care difficult if not impossible for a week or two. Discuss options with your doctor. Having both hands operated on at once may make sense if you have help at home and don’t mind having someone help you in the bathroom or when getting dressed. If not, it may be best to have one hand operated on, let it get better, and then have surgery on the other hand.
Another option: Modified open-release surgery
Some doctors offer a modified version of open-release surgery. It’s done the same as traditional open release, except your incision is shorter – about 1 inch in length. Because your scar is shorter, you typically have slightly less pain after the surgery. The disadvantage is that the view is more limited, so that incomplete release and accidental nerve injury may be somewhat more common than with release done through a larger incision. For this reason, some surgeons may not offer it.
Endoscopic surgery
Endoscopic carpal tunnel release (ECTR) surgery also is an outpatient procedure typically done in a hospital or surgical center operating room. As with open surgery, if you have carpal tunnel syndrome in both hands, you may have the option of having surgery on both hands in a single day, or only on one hand and delay the second hand for as soon as two weeks after the first procedure.
How is it done?
Your surgeon makes one or two small incisions called portals. Many surgeons deem it safer to make two incisions – one in the palm and one in the forearm just above the wrist (double-portal ECTR). With two portals, it may be easier for your surgeon to see that the carpal ligament has been completely cut. Each incision is about 1/2 inch long.

Other surgeons make just one incision – either in the palm or in the forearm just above the wrist (single-portal ECTR). Special instruments unique to each kind of technique help your surgeon to see well and to cut the transverse ligament safely.

A hollow, flexible tube is inserted through an incision hole, passing beneath the transverse carpal tunnel ligament. Your wrist must be cocked back quite far to get the tube to fit in properly. This part of the operation may be painful, unless you’re given some sedation. An attached video camera (endoscope) is inserted through the tube. The camera lets your surgeon see the ligament so that it can be accurately cut with tiny knives inserted through either the same or a different tube. The incision or incisions are then closed with stitches (sutures).

After the procedure
Your hand and wrist are wrapped in a bulky dressing. You can still move your fingers and thumb, but your wrist is confined to prevent you from bending it. A tube-like drain may be inserted through the bandages at the point where the ligament was cut, to drain off small amounts of bleeding that may occur. You’ll then be asked to bend and extend your fingers about five times every hour with your hand held over your head to stimulate circulation, decrease swelling and increase comfort. Most people require only a few over-the-counter pain pills for a day or two after surgery, such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin others), naproxen sodium (Aleve, others) or aspirin. You can go home within three to four hours. Don’t drive for 24 hours. Complications include nerve injury and infection, but these rarely happen – occurring in about one in 100 people. Symptoms usually don’t come back once they’ve gone away.
Recovery
One day after surgery, the dressing and drain are removed. Your hand is then placed in a plastic splint. The site where the drain was located is covered with antibacterial ointment. Keep the incision area clean and dry.

You wear the splint for two weeks. It keeps the wrist from bending down. Not bending your wrist helps the cut ends of the ligament heal. You can do light activities, such as driving, dressing and eating. Don’t lift anything heavier than a quart of milk (about 1 to 2 pounds).

• Two to four weeks. Two weeks after surgery, your sutures and splint are removed. Once the splint is removed, you may temporarily notice more discomfort. You may feel shocks or shooting sensations going to the fingers and up your forearm. You may have swelling on the little-finger side of your wrist. The area between the two small incisions where the ligament was cut usually feels hard. It may feel that things are getting worse, not better, but this is a normal stage of the healing process.

One day after your stitches and splint are removed, massage your palm for five minutes twice a day with a moisturizing lotion. This helps soften scar tissue forming at the incision sites and desensitizes the scar tissue beneath your skin.

• Four weeks and later. About four weeks after surgery, you can do heavier tasks such as vacuuming, mowing, gardening and sports activities. It will probably take three to four months before your hand feels fully recovered. Up to a year may pass before complete hand strength is back. Pain and numbness at night usually disappear immediately after surgery. Return of feeling in your hand may occur immediately, or take three to six months, depending on how severely your median nerve was compressed.

Some symptoms persist in a small number of people. Symptoms usually don’t come back once they’ve gone away.

As with open release, the advantage of having both hands operated on at once is that you go through recovery only once and don’t miss as much work. The disadvantage is that during recovery you will have limited use of both hands, which can make daily activities difficult.
Pros and cons
Which type of carpal tunnel release surgery you have – ECTR or OCTR – largely depends on your surgeon’s experience and your preference. ECTR and OCTR share similar outcomes. Both:

• Have excellent long-term success rates and low complication rates
• Restore muscle strength, manual dexterity and sensation in most cases

There are, however, some important distinctions between the two types of surgery, as well as the different techniques. Discuss these with your doctor.
ECTR

• Technique. Single-portal ECTR has the same overall success rate as double-portal, though single-portal has a slightly higher complication rate.
• Who shouldn’t have it. Don’t have ECTR surgery if your doctor discovers you have abnormal nerve anatomy or scarring from a previous surgery in the area – both of which are rare. If you’re having repeat surgery because your symptoms have returned, ECTR isn’t an option. On occasion, someone in the process of undergoing ECTR is quickly converted to OCTR, if soft tissues block view of key structures in the wrist.
• Complications. Complications such as a nerve injury are rare from any kind of carpal tunnel release, but are slightly higher for ECTR. Your chances of needing a second operation also are higher with ECTR than with OCTR – about one in 50 compared to one in 300. Partly, the need for a second operation arises from complications, but mostly, it’s because with ECTR there’s a slightly higher risk of not completely cutting the carpal ligament. If you choose ECTR, make sure your surgeon is properly trained and routinely does ECTR with low complication and reoperation rates.
• Recovery. ECTR usually has slightly less immediate post-surgical pain and tenderness at the incision sites than does OCTR. ECTR requires mild sedation. OCTR doesn’t.
• Return to work. Getting back to work after ECTR and modified OCTR is usually a few weeks earlier than for traditional OCTR. That’s primarily because the incisions are smaller.
• Cost. ECTR costs more than does OCTR for the actual surgery because an endoscope and sedation are needed. Long-term costs for both surgeries are similar and vary greatly depending primarily on whether complications arise and how long you’re off work. When you return to work depends mostly on your occupation, how motivated you are to return to work, and whether your employer can arrange modified duties for you.

OCTR

• Technique. OCTR uses a larger incision than does ECTR. This allows your surgeon to better see the anatomy of your hand and thereby reduces the risk of injuring a nerve or vessel. A larger incision makes initial recovery slightly more painful, though the discomfort is easily controlled with oral pain medication.
• Complications. Complications are rare and are slightly lower for OCTR than for ECTR. It’s extremely rare to need a second carpal tunnel operation after OCTR.
• Cost. OCTR costs less than ECTR for the actual surgery because less equipment and supplies are needed. Long-term cost is variable, depending mainly on whether complications arise and how long you’re off work.

Pros
For long-term symptom relief, surgery is more effective than splinting, injection or any other nonsurgical treatment.

Even if some symptoms remain after surgery, they tend to be less severe than those persisting or recurring after other types of therapies.

Despite the time it takes to heal, surgery works faster. Often, pain, tingling and numbness are gone immediately after surgery.
Cons
Surgery isn’t always a cure-all. Symptoms may lessen, but still persist. Hand strength may be slow to return to normal, or not return to normal.

Surgery may offer partial or no relief if another medical condition, such as obesity, arthritis or thyroid disease, is partly causing your carpal tunnel syndrome.

Possible surgical complications include nerve damage and infection, though both are rare.

For as long as four to eight weeks, you may not be able to perform your job or do other routine activities.
Alternative therapies
You may find alternative treatments for carpal tunnel syndrome on the Internet and in books and magazines. They include chiropractic adjustments and yoga, among others.

You might seek out alternative treatments for several reasons. You may be leery of surgery. Or you may find that conventional nonsurgical treatments offer little relief.

In some cases, researchers haven’t studied these treatments adequately using widely accepted scientific methods. In other cases, however, a growing body of evidence indicates that some alternative treatments may help relieve the symptoms of carpal tunnel syndrome.

• Vitamin B-6. No studies have produced reliable evidence that this vitamin improves the symptoms of carpal tunnel syndrome. And, although B-6 deficiency can cause nerve damage, so can toxicity from high doses of the vitamin. Finally, researchers have never found consistently lower B-6 levels in people with carpal tunnel syndrome than in those without it.
• Acupuncture. This may relieve some pain in some people with carpal tunnel syndrome, including those with persistent pain after carpal tunnel surgery. According to the National Center for Complementary and Alternative Medicine, acupuncture may be useful for treating carpal tunnel symptoms. Its effectiveness, however, hasn’t been adequately proved by research.
• Yoga. This can relieve carpal tunnel symptoms in some people. Yoga postures designed to strengthen, stretch and balance joints in the upper body can sometimes reduce pain and increase grip strength. These conclusions are based on a study of people with carpal tunnel syndrome who practiced 11 yoga postures twice weekly for eight weeks. Symptom relief often lasted up to four weeks after stopping yoga.
• Chiropractic. These methods of treating carpal tunnel syndrome use several manipulative therapies including stripping massage, transverse friction massage, skin rolling, tissue stretching, muscle exercises and joint manipulation. Most research concludes that none of these is effective.
• Laser therapy. This therapy is controversial. Some doctors recommend low-intensity laser light directed through the skin at the median nerve as a safe, cost-effective alternative to surgery, especially when used within the first year that you have symptoms. The laser beam is directed at several points along the median nerve during the course of several treatments. Some studies report that laser therapy (sometimes called laser acupuncture) gives some people significant long-term relief from symptoms. However, it’s not clear that laser therapy can reduce pressure in the carpal tunnel, and no long-term results have been reported. Many doctors are skeptical. Laser therapy isn’t a widely accepted treatment for carpal tunnel syndrome.
• Therapeutic touch. Therapeutic touch uses hands in a nontouching manner to focus and transfer “energy fields” from one person to another to heal the body. It does nothing to improve median nerve function or decrease pain in people with carpal tunnel syndrome.
• Magnet therapy. In this therapy, magnets are placed on the carpal tunnel area of the wrist. It offers no benefit to people with carpal tunnel syndrome.