Once the diagnosis of carpal tunnel syndrome has been established and underlying diseases associated with the condition have been treated with, then it is time to treat the condition.
Medication such as acetaminophen and non-steroidal anti-inflammatory drugs can be used for symptom relief. Splinting the wrist, especially at night, helps keep the wrist straight during the night and thus decrees the pressure on the median nerve. These splints, which are available in your rheumatologist's office or at many pharmacies, may relay symptoms, especially in milder cases.
A cortisone injection into the carpal tunnel area is often helpful in relieving symptoms for weeks to months and can be repeated. Injections should be done using ultrasound guidance. If there is an underlying disease, such as hypothyroidism (under active thyroid) or rheumatoid arthritis, causing the carpal tunnel syndrome, then treatment of the specific disease may also relieve symptoms.
Carpal tunnel syndrome occurring during pregnancy is often treated with splints and occasional diuretics. These drugs should be used sparingly. Carpal tunnel symptoms usually resolve after delivery.
When the above measures fail to alleviate symptoms, surgical opening of the tunnel to relieve the pressure on the median nerve, known as a carpal tunnel release, is probably indicated. In severe cases, early surgery may be considered. If there is significant muscle atrophy, surgical release is indicated over more conservative measures. However, if the carpal tunnel syndrome is very severe and has been present a long time, even surgery may not work. The surgery may be an open surgical procedure or an endoscopic procedure, and can be often done on an outpatient basis.
A new procedure may make surgical correction of carpal tunnel syndrome unnecessary. Percutaneous needle carpal tunnel release involves the use of a tiny needle that is inserted using local anesthetic and ultrasound guidance. The needle is placed in the flexor retinaculum, the tough piece of fibrous tissue that forms the roof of the carpal tunnel. The flexor retinaculum is pierced a number of times while at the same time, small amounts of fluid are injected to spread the fibers of the retinaculum, in essence, weakening the retinaculum. At the bend of the procedure, the patient's wrist is gently bent and the weakened retinaculum breaks open. A splint is applied and the patient may resume normal activities the next day.