Particularly in the early stages of carpal tunnel syndrome, attempts can be made to alleviate the symptoms by wearing special night splints or support bandages during the day. This type of treatment is particularly useful for young people with a short duration of the disease, pregnant women or patients in whom the cause is another disease such as diabetes mellitus or hypothyroidism, which can be treated separately.
The following measures may assist healing:
- Rest the hand and if the overuse is occupational, possibly start there with changes.
- At night, keep the wrist in a normal position with a splint.
- In case of inflammation, injecting cortisol into the carpal tunnel is effective, but not risk-free, as the nerve as well as the tendons could be damaged.
- The effect of diuretics (dehydrating agents) and non-steroidal anti-inflammatory drugs (anti-inflammatory drugs such as acetylsalicylic acid) has not been confirmed.
- Diuretics may be effective in cases of excessive fluid retention in the tissues, as is often the case in pregnancy. However, medication should generally be avoided during pregnancy.
If there is no improvement after eight weeks of treatment with conservative therapy, if the condition suddenly deteriorates rapidly, or if the sense of touch is severely impaired due to the nerve disorder, the KTS should be surgically repaired. In most cases, the operation is performed on an outpatient basis under local anesthesia. In the case of local anesthesia, the arm must also be anesthetized, since the arm's lack of blood, which is necessary for the operation, would otherwise cause severe pain.
The following two methods are generally used for the surgical treatment of KTS:
Open surgical technique: this requires a skin incision of about 3cm in the palm. Through this incision, the surgeon cuts the carpal ligament (retinaculum flexorum), a transverse, thickened ligament that spans the bone groove and forms the top of the carpal tunnel. Separation causes the ends of the ligament to diverge, enlarging the carpal tunnel and relieving pressure on the nerve. In addition, tissue, such as severely swollen tendon sheaths, is removed to create additional space.
If there is no previous damage to the nerve, it will recover through the relief of pressure alone and the symptoms of KTS will disappear. The surgical scar is usually almost invisible after six months.
This procedure is one of the most common operations for hand surgeons, usually takes only a few minutes and has a very low complication rate. Typical problems are a reduction in strength of the operated hand over several months, as well as scar discomfort.
Endoscopic surgical technique: Here the surgeon works endoscopically, i.e. from the inside with only an instrumental view of the surgical site. The necessary surgical instruments are inserted through a one to two centimeter long incision along the flexor crease of the wrist. The actual procedure is the same as open surgery.
This procedure has no clear advantages or disadvantages compared to open surgery - a lower scar pain, as well as a higher patient satisfaction with an uncomplicated course is possibly offset by a higher complication rate.
For a better healing of the wound, the wrist is consistently immobilized by a splint for a few days. To avoid swelling, the wrist should be elevated as much as possible. Daily finger and shoulder exercises help to restore mobility as quickly as possible. After about eleven days, the stitches are removed from the surgical site.
Depending on the surgical method, the hand can be used again for light work after one to two weeks. Healing is usually faster with endoscopic surgery than with open surgery. Normally, patients are not allowed to work or do sports for one to three weeks after the operation.
General consequences of medical procedures, such as postoperative bleeding or infection, rarely occur with this surgery.
With the open surgical technique, the scar may remain sensitive to touch for a long period of time and may cause pain when the hand is subjected to heavier loads. During surgery, the median nerve itself, or a small nerve branch that runs to the thumb, can be damaged. This results in numbness in the fingers and around the ball of the thumb.
Scar complaints occur much less frequently with endoscopic surgery, but there is a higher risk of complications during the operation (damage to the nerves). In some cases, the carpal ligament has to be cut incompletely and the operation has to be repeated. In the case of bleeding or unclear anatomy, there is also the possibility that the operation must be continued using an open surgical technique.