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Posted on Tue, Dec 13, 2011 : 5 a.m.

Carpal tunnel syndrome doesn't always require surgery

By Ask Dr. K

DEAR DOCTOR K:

I have carpal tunnel syndrome. My doctor wants me to consider surgery, but I'd like to learn about other treatment options first.

DEAR READER:

In carpal tunnel syndrome, a nerve that leads from your neck down your arm to your hand becomes trapped, or pinched, in your wrist. The nerve passes through a little tunnel (the carpal tunnel) in the wrist.

The tunnel is made of very tough tissue. Usually it is wide enough to allow the nerve to pass through it easily. But sometimes the tunnel gets narrowed and the nerve gets pinched. The classic symptoms are pain, weakness and tingling in the fingers. Often these symptoms occur at night and awaken you from sleep.

As the condition progresses, you may start to feel tingling during the day, and the pain may radiate up your arm. It may become difficult to make a tight fist or grasp small objects.

Carpal tunnel syndrome is more likely to occur in people who are overweight, during pregnancy and in people who work with their hands. People with diabetes, rheumatoid arthritis and hypothyroidism (underactive thyroid) are at higher risk for getting carpal tunnel syndrome.

There are several nonsurgical treatments you can try to relieve your symptoms. Most people improve with one or more of them:

-- Self-help. Rest the affected hand for at least two weeks, avoiding any activities that make your symptoms worse. In particular, avoid prolonged periods of gripping and pinching.

-- Wear a splint to keep your wrist straight. If it is impractical for you to wear one during the day, wear one at night for sure. People can sleep in the strangest positions, and some positions flex the wrist and pinch the nerve harder. You can find splints at most pharmacies.

-- Hand exercises may help. Consult a hand therapist for specific exercise recommendations.

-- Despite what you may have heard, nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen and naproxen are not effective for treating carpal tunnel syndrome.

-- Corticosteroid injections relieve symptoms in some people. They can reduce swelling and inflammation inside the carpal tunnel that may be pressing on and irritating the nerve.

-- Yoga can reduce pain and improve grip strength. If you try this option, find a well-qualified instructor who understands anatomy and can help you adjust the poses as needed.

-- Acupuncture may be helpful, either in addition to or instead of other therapies. Acupuncture can be costly, but it might be worth a try if you'd prefer to avoid surgery.

We have more information on carpal tunnel syndrome in our Special Health Report, "Hands: Strategies for Strong, Pain-Free Hands." You can find out more about it at my website.

If you continue to have persistent numbness and pain for more than six months and have trouble gripping or grasping things, you may want to reconsider surgery. Many surgical procedures use local anesthesia and don't require an overnight hospital stay.

(Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.AskDoctorK.com.)

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