Carpal tunnel syndrome non-surgical
What are the symptoms and signs? Some common causes and associated conditions are: • repetitive and forceful grasping with the hands Mild cases may be treated by applying a brace or splint which is usually worn at night and keeps your wrist from bending. Resting your wrist allows the swollen and inflamed synovial membranes to shrink; this relieves the pressure on the nerve. These swollen membranes may also be reduced in size by medications taken by mouth called non-steroidal anti-inflammatory drugs.
In more severe cases, your doctor may advise a cortisone injection into the carpal tunnel. This medicine spreads around the swollen synovial membranes surrounding the tendons and shrinks them, and, in turn, relieves the pressure on the median nerve. The dosage of cortisone is small. In fact in a recent study (Ly-pen D, et al. Arthritis Rheum 2005; 52: 612-9), steroid injection was as effective as surgery after one year of follow-up.
Other forms of non-surgical treatments include taking a low dose of vitamin B-6, using splints, and also performing certain types of exercises and massage. Ice helps reduce swelling. Fill a bag with ice and place it over the area that is inflamed. Keep it there just until the area goes numb. Then remove it and repeat the process. This creates what is call a vascular flush. Your veins constrict and release in such a way that drains excess fluid from the area. In the case of carpal tunnel, you would do best to rest your hands and forearms in a bin of ice water just until you can no longer feel the cold. Then remove them. Let them return to normal and then repeat. Lymph drainage is another technique for reducing swelling. Vessels for the drainage of lymph fluid exist directly underneath the skin so you pressure need only be very light. Start in the crease of your elbow making circular movements. Then use your opposite hand to jostle the skin of your entire forearms for about a count of 20. Then lightly glide your hand over the skin from the wrist to the elbow about 20 times. This will begin the drainage process. Physical exercise is a powerful lymph drainer for the entire body. This can be done in as little as 5-10 minutes a day. Just enough to really get your heart rate up. If there has been much inflammation in the forearms from carpal tunnel, the tendons and muscle can adhere to one another. This exercise is designed to begin the process of releasing these restrictions. Please be careful. These techniques are powerful and you do not have to push hard. Do not allow yourself to push to the point of pain. Simply release the first layer, then go back and release the next layer and so on. Take it slow. Never move your stroke towards the wrist. This will just push the fluid into the carpal tunnel. Move your stroke either up towards the elbow, or sideways across the forearm. While performing these strokes play with contracting and relaxing the muscles underneath your elbow. You do this by moving your wrist around. Release both the flexors and the extensors of the wrist. Begin down by the carpal tunnel of the wrist. Sink your elbow into the tissue slightly. Move your elbow up the arm creating a moderate tug on the tissue. Continue up the arm until you reach the elbow. Perform this action a few times making a point to cover the entire forearm front and back. Contract and relax the muscles as you perform the stroke. It is also an important stretch for the muscles of the wrist and carpal tunnel. If you cannot make a fist to perform these movements due to nerve impingement, use your other hand to assist you in stretching.
Hold your hand out in front of you. Make a fist and flex your wrist. Slowly rotate your wrist around feeling the stretch, then open them so that your palms are facing upwards. Now extend your wrists. Feel the stretch. Make a fist again and slowly rotate them back their original position. I would do this over and over again for about five minutes a day. The thumb stretch is designed to stretch the tendon in the wrist that operates the thumb.
Begin by wrapping your fingers around your thumb. Then stretch your wrist downwards as shown tugging on your thumb. You should feel a stretch in the tendons of your lateral wrist (thumb side). Hold this stretch anywhere from one to five minutes. You do not need to create a forceful pull. A gentle sustained tug should suffice. When you come out of the stretch be sure to come out slowly. This stretch is to be performed once per day.
In those patients who do not gain relief from these non-surgical measures it may be necessary to perform surgery. The surgery itself is called a "release" - cutting the ligament that forms the roof of the carpal tunnel to relieve the pressure on the median nerve. The surgery is usually performed in an outpatient facility and you are generally not required to stay over night. Your doctor can explain to you the likelihood of non-surgical or surgical treatment based on your own individual circumstances. One type of treatment he or she may not know about is very new. It is called percutaneous, ultrasound-guided, needle release. With this technique, ultrsound guidance is used to direct a small gauge needle using local anesthetic. The needle is gently inserted into the flexor retinaculum (the tough ligament that forms the roof of the carpal tunnel. The flexor retinaculum is fenestrated (pierced with a number of holes) while at the same time a mixture of lidocaine and sterile saline are used to "hydrodissect" (spread apart)the fibers of the retinaculum. It is akin to creating perforations in a piece of paper. At the end of the procedure, the wrist is flexed (bent towards the patient) and the flexor retinaculum breaks apart at the site of the perforations. No surgical incision of any type is required. Relief is immediate with no down time.
|
