Left untreated, carpal tunnel syndrome (CTS) can ultimately lead to permanent atrophy (wasting) of the hand muscles. Treatment for CTS with a physician specializing in the disorder should begin as soon as possible to avoid permanent damage to the median nerve, one of the nerves that control hand and finger movement and sensation.

Physicians will treat any underlying causes of CTS first (e.g., diabetes, hypothyroidism, rheumatoid arthritis). In some cases, symptoms (pain, tingling and numbness in the arm, hand and/or wrist) improve with treatment of the underlying cause.

Initial treatment of CTS generally involves resting the affected hand and wrist for up to two weeks, avoiding activities that might exacerbate symptoms (e.g. knitting, use of power tools) and applying cool packs (cryotherapy) to reduce swelling.

For those whose jobs involve extensive hand movement, a physician may recommend the use of an elastic glove. Also, a physician may recommend strength and stretching exercises to maintain wrist strength and mobilize nerves and tendons.

In addition, studies sponsored by the National Institutes of Health indicate that yoga and acupuncture may also help relieve CTS pain.

If these techniques do not work, a physician may recommend:

• Wrist splinting. In this type of conservative therapy, a patient wears a splint that holds the wrist in a slightly extended position (bent upward) to help relieve symptoms of tingling and numbness. Sometimes splints are worn only at night, but full-time use may be recommended to maximize benefits. Splinting is more likely to be effective if a patient has only mild to moderate symptoms for less than a year. Splints are available premade, or they can be individually designed by an occupational therapist or a physical therapist.
  
  
• Anti-inflammatory drugs. In cases where inflammation is present, the short-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) or oral corticosteroids may help control pain caused by CTS. However, if no inflammatory condition is present, these medications are unlikely to help relieve symptoms.
  
  
• Injection therapy. A physician can inject the carpal tunnel with medication such as a corticosteroid or local anesthetic to relieve the pain. However, this procedure can be risky and should be performed only by physicians with specific training in carpal tunnel injection. If injected incorrectly, it can result in nerve deterioration and, in worst cases, permanent deformity of the hand.

Surgery may be recommended for CTS patients whose symptoms are severe or after other noninvasive treatments have failed to show improvement for at least six months. Carpal tunnel release is one of the most common surgical procedures in the United States. There are three types of carpal tunnel release procedures, and all involve severing the band of tissue around the wrist to reduce the pressure on the median nerve:

• Open release surgery. The traditional procedure to correct CTS, it consists of making an incision (no larger than 2 inches) in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel and remove pressure on the median nerve.
  
  
• Endoscopic surgery (arthroscopy). This type of surgery is performed using an endoscope (thin tube attached to a tiny television camera) which allows the surgeon to see inside the carpal tunnel and perform the surgery through small incisions in the hand or wrist. This procedure is less traumatic, and the patient may recover faster.
  
  
• Small palmar incision. A physician makes a small incision in the palm of the hand over the carpal tunnel and releases the nerve. With this procedure, there is less risk of injury to vital structures and the scar is smaller so the patient experiences less pain during recovery.

After carpal tunnel release surgery, pain, tingling and numbness typically improve within six weeks. Weakness and functionality improve more gradually. Grip and pinch strength may worsen at first, then return to preoperative levels in about three months, and improve significantly by two years. Studies indicate that the majority of CTS patients who undergo surgery are very satisfied with the results.

To promote recovery after surgery, physicians may recommend that patients avoid alcohol, tobacco and exposure to any type of repetitive, forceful activities involving the use of the hand or fingers. Studies indicate that CTS patients who smoke take longer to recover from carpal tunnel release.

Rarely, there may be complications after carpal tunnel release surgery. For example, some patients may experience infection, nerve damage, stiffness and pain at the scar. In a few cases, the wrist may lose strength because the carpal ligament is cut. In such cases, physicians may recommend occupational therapy or physical therapy, preferably from a certified hand therapist (CHT), to restore wrist function.

After recovery from surgery, some patients may need to adjust their job duties or, if necessary, change jobs.

After treatment, recurrence of CTS is rare, and most patients recover completely, according to the National Institutes of Health. In addition, most CTS patients recover with conservative (noninvasive) treatment, and less than a third of patients require surgery.