What are the treatments for carpal tunnel syndrome?

• There are different types of treatment for carpal tunnel syndrome depending on its severity.
• One of the initial treatments for carpal tunnel syndrome is painkillers or corticosteroids.
• In the most severe cases, the only solution for carpal tunnel is surgical treatment.

Carpal tunnel syndrome is the inflammation and compression of the tendon, vascular and nerve structures that pass through the carpal tunnel. The carpal tunnel is the anatomical space bounded by the flexor retinaculum and carpal bones found in the wrists of both hands. 

This syndrome is mainly characterised by the presence of pain in the form of electric shocks, tingling and even muscle weakness in both hands, mainly in the first three fingers of the upper extremity. It is mainly caused by compression of the median nerve as it passes through the carpal tunnel. It is usually predominantly nocturnal, affecting throughout the day in the most severe cases.

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The causes of carpal tunnel syndrome are diverse and multifactorial. The main causes include a strong genetic predisposition and the acquisition of these disorders through repetitive hand and forearm movements, especially in certain work and leisure activities.

In order to clarify the sequential treatment of the pathology known as carpal tunnel syndrome, it is essential to establish a classification according to the degree of inflammation and involvement of the median nerve, as mentioned above, and the symptoms and problems that this pathology causes in the daily life of patients suffering from carpal tunnel syndrome.

In a simple and schematic way we can classify carpal tunnel syndrome into 3 levels of severity: mild, moderate and severe.

Mild carpal tunnel syndrome

The treatment of mild carpal tunnel syndrome is primarily medical treatment. Patients with mild carpal tunnel syndrome experience discomfort and tingling at the end of the working day and after intense or repetitive manual exercises.

In this type of patient, mild compression of the median nerve is common and the degree of inflammation of other structures adjacent to the median nerve, such as tendons and muscle fibres passing through the carpal tunnel, is the cause of most of the symptoms explained above.

In this sense, pharmacological treatment with anti-inflammatory drugs for an average of 7-10 days reduces the inflammation of these carpal tunnel structures and thus reduces the symptoms characteristic of this degree of carpal tunnel syndrome. The use of pure analgesics or molecules such as pregabalin can improve during acute episodes of pain and prolong the onset of pain over time.

Moderate carpal tunnel syndrome

In the treatment of moderate carpal tunnel syndrome, symptomatic control with purely pharmacological medical treatments and the administration of more or less invasive techniques such as corticosteroid infiltrations are fundamental. In this type or degree of carpal tunnel syndrome, compression of the median nerve is more important than in mild degrees, so that it is necessary to focus more intensely on the specific aetiology of the lesion to this type of structure.

Taking drugs such as pregabalin improves the inflammatory and compressive symptomatology over the course of days. 

Rehabilitation exercises and care in the performance of activities that promote the onset of carpal tunnel syndrome play a much more decisive role in the management of the acute phases of the disease and in the latency of these same acute episodes. 

In many cases, simply taking anti-inflammatory or purely analgesic drugs does not sufficiently improve the progression of the disease or its severity.

On these occasions, the administration of anti-inflammatory substances such as corticosteroids or corticoids through infiltration in the carpal tunnel region achieves a much more targeted local treatment that allows an improvement in the symptoms of carpal tunnel syndrome in an average of 6-8 months thanks to the action of these drugs at the site of the inflammation that causes carpal tunnel syndrome.

Severe carpal tunnel syndrome

The treatment of severe carpal tunnel syndrome is mainly based on surgical intervention. Performing surgery for the resolution of carpal tunnel syndrome is the only therapeutic measure that ensures non-progression of the disease and resolution in the vast majority of cases.

In severe degrees of carpal tunnel syndrome, the compression of the median nerve is severe and the characteristic symptomatology of pain, tingling, numbness and functional impotence is present throughout practically the entire day, without the need for specific efforts with the hand. At this point, a surgical solution is the only method that ensures a fundamental improvement in the patient's quality of life.

Basically, two types of surgical interventions can be performed to treat carpal tunnel syndrome: open access through an incision in the wrist of the affected hand and endoscopic access through micro-openings using an optical source in a surgical instrument in the form of a cylindrical tube that accesses the interior of the carpal tunnel and allows the section of the inflamed ligament (flexor retinaculum) that serves as a roof for this anatomical composition and that is the final resultant of the pathogenesis of this type of disease.

The fundamental difference between these two types of surgery is based on an aesthetic improvement and early return to work in those who undergo surgery with endoscopic access, with similar or even fewer complications in those who undergo surgery with open access.

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