Carpal tunnel syndrome (CTS) usually presents with numbness and tingling of the thumb, index and middle fingers and can often be accompanied by wrist pain, particularly at night. We recently covered one modern surgical treatment for carpal tunnel syndrome, but there are also non-surgical options as well.
What does carpal tunnel syndrome look like?
Carpal tunnel syndrome is the most common upper extremity neuropathy that our surgeons at Proliance Hand, Wrist and Elbow face. Patients often present with problems sleeping as they feel pain and tingling in their hand and wrist. The numbness classically involves the thumb, index, middle and part of the ring fingers, but some patients sense it in the entire hand. The pins and needles sensation can be very painful and many people describe trying to “get the blood flow,” back in the hand. These symptoms can present slowly over many years or more quickly depending on a variety of factors.
What can I expect from conservative carpal tunnel syndrome management?
As with many conditions, treatment starts conservatively trying to manage the severity and duration of symptoms. Inflammation and overuse play significant roles in carpal tunnel syndrome and certainly rest with avoidance of aggravating activities can help. Nocturnal use of a wrist brace can help as well to decrease the pressure in the wrist. Many patients sleep in a position with the wrists fully flexed or bent towards the elbow. Research shows this wrist flexed position increases the pressure on the median nerve within the carpal canal. Over prolonged periods of time this position contributes to the nocturnal waking episodes that many patients describe.
The American Academy of Orthopedic Surgeons strongly recommends trying wrist immobilization as a conservative management program. The same strong recommendation is made for corticosteroid injections into the carpal canal. But how do the two treatment options compare?
Wrist immobilization vs. steroid injections:
Recent research has confirmed what many patients and surgeons have experienced: that steroid injections tend to have better outcomes and longer relief from carpal tunnel syndrome symptoms than splinting.
One study recently appeared in Lancet; one of the top, if not top, journal in the field of medicine. Researchers randomized a group carpal tunnel patients to treatment with either nocturnal wrist immobilization with a wrist brace or a corticosteroid injection. The study compared outcomes 6 weeks after starting treatment and there was a clear benefit from steroid injections over bracing. The patients that underwent steroid injections had significant improvements in hand-wrist pain intensity and hand-related insomnia compared with patients who received wrist braces. This study also found that steroid injections are the most cost-effective way to reduce mild to moderate carpal tunnel syndrome for the six months after treatment.
This year, the Journal of Hand Surgery published another study which found similar benefits of corticosteroid injections over wrist braces. In this study the benefit of steroid injection lasted for the entire six-month duration of the research. Both treatments made improvements according to self-reported questionnaires, but corticosteroid injections were significantly better.
How Can Proliance Hand, Wrist and Elbow Physicians Help?
A consultation with Proliance Hand, Wrist and Elbow Physicians can help determine if your hand might benefit from a steroid injection if you suffer from carpal tunnel syndrome. Our highly trained occupational therapists are onsite at our Kirkland and Bellevue offices for your convenience to see your hand surgeon and therapist quickly and conveniently. Whether it is time to try a splint, steroid injection or surgical intervention, our staff can help. Contact us to make an appointment at any of our five convenient Eastside locations.
About the Author:
Samuel E. Galle, M.D. is a board-certified orthopedic surgeon with subspecialty fellowship training in conditions of the hand and upper extremity. He has published numerous peer-reviewed articles and surgical technique videos. He lives in Kirkland, WA with his wife, two kids and one especially spoiled Cavalier King Charles Spaniel.
