Treatment Options
3) Treatment Options: There are many different treatment options for Carpal Tunnel Syndrome. Which option is employed is based on your physician's clinical judgment. Options include:
CONSERVATIVE
Night Splinting - the wrist is splinted in a straight or slightly extended position to prevent flexing the wrist which can compress the canal and bring on symptoms.
Steroid/Anesthetic injection into the carpal tunnel
- A mix of a steroid (a drug which decreases inflammation) and a local
anesthetic (numbs the area after the injection) are injected directly into
the canal in an attempt to decrease the inflammation and swelling in the
canal, thereby decreasing the compression on the median nerve and the patient's
symptoms. This approach is often employed before surgery is considered.
It not only serves as a treatment option, it can be used as a diagnostic
tool if the diagnosis is not certain (if the injection relieves the symptoms,
CTS was most likely the correct diagnosis).
SURGICAL
Open decompression - An incision is made in the palm under local (only the area involved is numbed) or general anesthesia (patient sleeping), the transverse carpal ligament (the roof of the carpal tunnel) is visualized and cut.
Endoscopic decompression - Two smaller incisions are made in the wrist and palm, and an endoscope (a small lighted tube containing a camera) is passed through the carpal tunnel through these incisions. The surgeon then visualizes the transverse carpal ligament (the roof of the carpal tunnel) and cuts it, freeing the contents of the carpal tunnel from the compression.
*The ligament eventually heals back together with both surgical techniques, but it is longer than it was before the surgery and therefore there is more room in the tunnel and the nerve compression ceases to occur.
**The endoscopic technique employs smaller incisions, and therefore, the recovery time is faster than with the open procedure. However, because it is more difficult to visualize the ligament and nerve through the endoscope, there is a slightly increased risk of nerve damage at the time of surgery, but this is greatly dependent on the surgeon's experience with the procedure. It is important to discuss the different techniques with your physician.
***Certain situations warrant choosing the open technique over the endoscopic technique. For example, if the patient has already had an unsuccessful endoscopic release (the patient continues to have symptoms after the endoscopic procedure) then another endoscopic procedure is not performed because the scarring that occurs after the procedure would make visualizing the contents of the tunnel more difficult and the risk of nerve damage would be increased. An open procedure could be safely employed to relieve the symptoms. One situation where the open procedure is often used initially is in patients with rheumatoid arthritis, as the extensive inflammation and scarring caused by this condition may make the endoscopic procedure more difficult. Again, it is important to discuss with your physician as to which technique he/she prefers and which is most appropriate for you.
****Long term studies have found both techniques to be equally effective (no significant difference in eventual outcome between patients treated with endoscopic versus open carpal tunnel release), and cost-effective analyses have found endoscopic carpal tunnel release to be cost-effective.
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