What alternative methods are available to treat CTS and other RSI?

Generally, the standard course of treating Carpal Tunnel Syndrome (“CTS“)is to begin with the least disruptive and least expensive options, proceeding, as necessary to more involved procedures. Conservative treatment, going next to medical treatments, and using surgical treatments only in the most extreme cases.

CONSERVATIVE TREATMENTS

The primary purpose of conservative treatment is to allow the ailing tissue or nerve to heal itself. The three most common forms of conservative treatment include:

  1. Wrist Splint– For Carpal Tunnel Syndrome and other Repetitive Stress Injuries involving the hand and wrist, many doctors prescribe a splint to immobilize the injured area and allow it recover. The splint keeps the wrist in a neutral position, allowing the opening of the carpal tunnel and the passageway for the ulnar nerve to remain as large as possible.Another type of splint for “CTS” consists of a stiff, straight piece that rests against the back side of your lower forearm and hand. Elastic straps at both ends effectively immobilize your wrist, but allow you considerable freedom of movement with your hand and fingers, an advantage over other splints. This is a relatively new approach but many people with “CTS” who have tried it report that it seems to work well.Whenever immobilization is used, there are three things to be concerned about. First, your muscles may lose their tone. This is usually not serious if the period of immobilization is just a few weeks, since you will regain muscle tone quickly with exercise. Second, joints can be overcome quickly with exercise. Finally, anyone wearing a splint and trying to continue to do their job can instead aggravate their condition.
  2. Hot and cold Compresses are sometimes used as part of conservative treatment. Cold should be applied soon after swelling occurs to reduce the swelling and to allow as much mobility as possible in the affected area.Heat can increase blood flow in soft tissue such as muscles and tendons and aid in healing and reducing pain or discomfort. If an area is swollen, heat should be avoided since increased blood flow can add to the swelling.
  3. Exercise and physical therapy are useful only after your condition has been stabilized and the injured tissue is recovering. Even then, they should be done only under supervision of a physical therapist or another health professional.Generally, exercises stretch your muscles and tendons, improve blood circulation, reduce muscle tension and improve joint motion. It is always a good idea as a preventive measure to exercise before you start work and periodically through the working day.

MEDICAL TREATMENTS

Many doctors prescribe medicine for “CTS” and consider medical treatment a type ofconservative treatment. There are several medical treatments that are used primarily to reduce inflammation which allows damaged tissue to heal, including:

  1. Aspirin and ibuprofen often are recommended because both reduce swelling of inflamed tissue and relieve pain. In addition, they are inexpensive and readily available. For many “CTS” cases, immobilization, rest, and one of these anti-inflammatory painkillers is sufficient for full recovery. Ibuprofen is a nonprescription type of nonsteroidal anti-inflammatory drug (NSAID).
  2. Corticosteroids can be injected directly into inflamed tendons and bursa. Because the drug is delivered directly to the site, it can produce dramatically quick and significant reductions in swelling, often within forty-eight hours. Some patients initially feel worse, but most feel better quickly. Success depends primarily on accurate location of the damaged tissue.

SURGICAL TREATMENTS

Some advanced cases of “CTS” must be treated surgically or the nerve damage will continue to worsen.

What is most difficult is deciding when surgery must done. Many hand surgeons recommend carpal tunnel release surgery without hesitation. As operations go, it is simple, the risks of complications are small, and the chances of success are good. There is some concern that the long term results of carpal tunnel surgery may be less than glowing, however.

The objective of carpal tunnel surgery, or carpal tunnel release, is to sever the carpal ligament, a tough connective tissue that crosses the wrist at the base of the hand. (It is know medically as the flexor retinaculum.) The primary purpose of the ligament is to hold in place the tendons that pass through the wrist’s carpal tunnel along with the median nerve. Since “CTS” is the result of compression of the median nerve by the tendons, it seems logical to relieve pressure on the nerve by effectively unbanding the area (see graphic).

The traditional surgical method in use for more than four decades is known an open carpal tunnel surgery. An incision of about two inches is made through the skin covering the carpal ligament. The ligament is then severed.

More recently, surgeons have developed a “closed method” called endoscopic surgery, a procedure that allows the doctor to see and operate inside your palm and wrist through very small incisions. The surgery is done through one or two small incisions using a thin, telescope-like instrument called an endoscope. A video camera attached to the endoscope records images that your surgeon can view on a monitor.

During the surgery, using specially designed surgical tools, your doctor cuts (releases) the transverse carpal ligament. This increase the tunnel space so that the median nerve is no longer under pressure. The entire surgical procedure generally takes less than an hour, and is usually performed on an outpatient basis. Because a large incision is avoided, endoscopic surgery may cause less pain and allow for faster healing than the traditional “open surgery.”

While open surgery often keeps the patient from returning to work for as long as several months, the majority of patients who undergo the endoscopic release are able to return to work within a week to ten days.

IMPORTANT NOTEClinical studies on a unique new surgical procedure called Balloon Carpal Tunnel-Plasty, have recorded excellent results and a high patient satisfaction rate of 95%. The procedure utilizes a balloon catheter device similar to an angioplasty balloon, dilates and expands the transverse carpal ligament, as opposed to the “traditional;” open and closed carpal tunnel surgeries which sever (release) the ligament. The “inflated balloon” increases spatial diameter of the carpal tunnel and relieves pressure on the median nerve alleviating symptoms of “CTS”.

Like all surgery, carpal tunnel release surgery (open or closed) involves risks and complications, including damage to blood vessels which could lead to excessive bleeding, infection and in rare cases, nerve or tendon damage leading to temporary or permanent numbness. In addition, a high number of people who have carpal tunnel release surgery find that their symptoms reoccur though usually not as severely as they originally occurred.

Ultimately, the best treatment for Carpal Tunnel Syndrome and other types of Repetitive Stress Injuries may be identifying the factors that caused the disorder and the correcting them. When that cannot be done, the choice may be between your job and your health.

An official of the National Institute of Safety and Health, summarized the problem the best by stating “if a complete and permanent recovery is expected, it is important the worker is not returned to the same job or task that precipitated the RSI.”