Lingua/Sprache/Language          -   Last updated 08 May 2008

How is carpal tunnel syndrome treated?

Treatments for carpal tunnel syndrome should begin as early as possible, under a doctor's direction. The "Clinical Guideline on Wrist Pain" from the American Academy of orthopedic Surgeons and American College of Occupational Environmental Medicine recommends that patient with carpal tunnel syndrome modify his activities for two to six weeks while he is treated with wrist splint and nonsteroidal antiiflammatory medication. If these therapies are ineffective, or if patient has thenar muscle atrophy or weakness recommend referral to a specialist for injection or surgery. If carpal tunnel syndrome seems likely, conservative management with splinting should be initiated and patients should reduce activities at home and work. Where this is possible, patients should wear the splint during work . Important, for this aim, is the new wrist brace Policarpal. It is the latest generation product as it acts on the main cause of the problem. In fact, although it allows normal use of the hand (including thumb) and can be easily used during the day or at night, it effectively limits the bending-extension of the wrist (main cause of the problem). It can also be used by pregnant women. The hand can be used freely. If the condition fails to improve, the clinician should discuss the options of corticosteroidal injection and surgical therapy. Injection is effective if there is no loss of sensibility or thenar muscle atrophy and weakness and if symptoms are intermittent. More than 80 percent of patients with carpal tunnel syndrome report that a wrist splint alleviates symptoms. Splinting also reduces sensory latency, and so perhaps may alter the cause of carpal tunnel syndrome. Splint are more effective if maintain the wrist in neutral position. Nonsteroidal antiiflammatory medications, diuretics, and pyridoxina (vitamin B6) have been studied in small trials, with no evidence of efficacy. The prednisolone (20 mg daily for two weeks, followed by 10 mg daily for two weeks) makes a reduction in symptoms, but in the few studied patients were not followed after the four weeks. Patients who remain symptomatic after modification of activities and splinting can make injection of corticosteroids into the carpal tunnel. Symptoms generally recur within one year. The risks of injection and nerve damage resulting from injection are considered low but have not been formally studied. The optimal number of injection per year has not been studied. Acupuncture for carpal tunnel syndrome has not been evaluated in controlled studies. If a patient has symptoms and signs for an axonal loss - costant numbness, loss of sensibility and thenar muscolar atrophy or weakness - surgery should be seriously considered. Surgery is done under local anesthesia and does not require an overnight hospital stay. Many patients require surgery on both hands. The operation consists in cutting the ligament through the carpal (roof of carpal tunnel). This can be done using the traditional technique or by endoscopy. The operation must not be left until it is too late as there is risk of permanent damage. More than 70 percent of patients report being completely satisfied or very satisfied with carpal-tunnel surgery (tradional or endoscopic); 70 to 90 percent of patients report being free of nocturnal pain after surgery. There have been no randomized controlled trials comparing carpal tunnel release with conservative therapy. Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months. The majority of patients recover completely. Some patients may have infection, nerve damage, stiffness, and pain at the scar. Occasionally the wrist loses strength because the carpal ligament is cut.

TABLE OF CONTENTS

• What is Carpal Tunnel Syndrome?
• What are the symptoms of carpal tunnel syndrome?
• Who is at risk of developing carpal tunnel syndrome?
• What are the causes of carpal tunnel syndrome?
• How is carpal tunnel syndrome diagnosed?
• How can carpal tunnel syndrome be prevented?
• How is carpal tunnel syndrome treated?

|  Home  |  Order  |  About us  |  Faq  |  Literature  |  Links  |