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How can carpal tunnel syndrome be treated?

Q: I am a 30 years old man recently diagnosed with carpel tunnel syndrome in both the hands. I have been taking steroids - Tryptomer 20 mg for the last 4-5 months but there is little improvement. Now, the doctor has asked me to go for surgery. Please advise.

A:Carpal tunnel syndrome is the term used to describe a group of symptoms associated with compression of the median nerve at the wrist and is most commonly diagnosed site of compression in the upper limb. Symptoms include paraesthesia and/or numbness in the median nerve distribution of the hand (thumb, index, middle finger and one half of ring finger). The symptoms are more in the night and it disturbs the patients from sleep. There will be weakness of thumb to touch the little finger (called as Abduction). Carpal tunnel syndrome is a clinical diagnosis (doctor diagnoses it), based on your symptoms and findings. Its presence may be subsequently confirmed with NCV/EMG (Nerve Conduction Velocity and Electromyography). This test is to check the functional integrity of median nerve in the wrist. A number of non-operative treatments (no surgery) have been described. They are

  1. Cotricosteroids injections (Reported 11% relief in patients and it takes 12-18 months longer time)
  2. Wrist splints (Maintaining the wrist in neutral position will minimise the pressure around the median nerve). The limitation is you can’t work with the hand
  3. Medicines (NSAIDS - Voveran, Aspirin, etc.) - They have not proved successful.
I would recommend you to undergo surgery if you have:
  1. Classical symptoms, which I have mentioned (numbness, sleep disturbances, night pains, etc.)
  2. Confirmed with NCV/EMG tests
The surgery is to release the tight Transverse Carpal ligament over the median nerve. It relives the compression around the nerve. Your symptoms and performance of work after surgery will definitely be better.


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