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Carpal Tunnel Syndrome: Part 3 - Treatment

Non-surgical physical therapy treatment

Patients that respond to non-surgical treatment tend to be those with less severe symptoms and those that do not have wasting of the thumb muscles. These treatments may include:

 Hands on physical therapy treatment called manual therapy

 Orthosis/splint - to immobilize the wrist in a near neutral position to maximize the size of the carpal tunnel and reduce the amount of tendon movement in the tunnel thereby reducing the swelling within the tunnel. The orthosis/splint is also worn at night during sleep.

 Superficial heat and interferential current (an electrical stimulation machine) may give temporary relief

 Ultrasound – there is conflicting evidence on the effectiveness of ultrasound for carpal tunnel syndrome

 Advice to change aspects of a computer workstation if indicated. This may include modifications to place the wrist in a more neutral position, modifications to the keyboard to reduce the force required to strike the keys, and changes to the duration of using a mouse (alternate hands or change to touch screen)

Other treatments beyond the scope of this blog:

Other non-surgical treatments include steroid injections (not performed by a physical therapist). When non-surgical treatments fail or when symptoms are prolonged and severe, surgery may be recommended to release the carpal ligament.

Carpal Tunnel Syndrome Part 4 will cover the physical therapy manual treatment in more detail.

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References:

1. Carpal Tunnel Syndrome. American Academy of Orthopaedic Surgeons available at: https://orthoinfo.aaos.org/en/diseases--conditions/carpal-tunnel-syndrome/

2. Erickson M, Lawrence M, Stegink Jansen CW, et al. Hand pain and sensory deficits: Carpal tunnel syndrome. J Orthop Sports Phys Ther 2019; 49(5):CPG1-CPG85. Link: https://www.jospt.org/doi/full/10.2519/jospt.2019.0301