“For
the last few months, I’ve been waking up at night with numbness and tingling in
my hand. Lately, I’ve been waking up
more often, 3-4 times a night and I’m having a hard time falling back to
sleep. When I drive, my hands fall
asleep within a few minutes and I have to shake my hand and fingers to wake
them up. This has gotten to the point where I have to do something but I really
don’t want surgery. What are my
non-surgical options?”
CTS or, carpal tunnel syndrome is a
condition where a nerve (called the median nerve) that travels down from the
neck into the arm and through the wrist becomes pinched and inflamed. Common symptoms include numbness, tingling,
dexterity problems (such as difficulty buttoning shirts), and opening jars due
to weakness in grip and pinch strength. Sleep interruptions and loss of many
daily activities, including work, occur because of CTS.
There are many non-surgical
approaches to the treatment of CTS that should be utilized before surgery is
considered, according to the American Academy of Neurology. In one study, 40% of neurologist polled
recommended non-surgical care due to the potential side effects of surgery,
some of which being severe, resulting in lengthy work loss
post-surgically. A partial list of
non-surgical care options include:
- Rest – Giving the
inflamed CTS time to heal is therapeutic but not always an option.
- Activity/job
modifications – Avoiding certain activities or modifying them by taking breaks
during the work day, slowing down the pace of the job, altering the
position of the job task, such as propping up a part so that the wrists do
not have to bend to the extremes,
or when necessary, complete avoidance of the job task.
- Wrist Splint – This
is a brace that maintains the wrist in a neutral position so it cannot
easily bend. When the wrist flexes
or extends, the pressure inside the carpal tunnel (on the palm side of the
wrist) increases significantly, placing additional pressure on the already
pinched median nerve. Wrist splints are especially useful at night.
- Nerve Gliding
Exercises – These are exercises that stretch the wrist joint and muscle
tendons (as well as the median nerve inside the carpal tunnel), with the
objective of breaking adhesions that limit the normal glide or movement of
the nerve in the forearm and wrist.
- Manual therapy
techniques – These include manipulation of the arm including the forearm,
wrist, and hand and sometimes the neck and shoulder, when needed. The objective is to improve the range of
motion of the joints and soft tissues that may be participating in the
process of median nerve pinching.
- Anti-inflammatory
medication / nutrients – Medications include aspirin, ibuprofen, naproxen
and similar prescription drugs. Nutritional options including herbs (such
as ginger, turmeric, boswellia), digestive enzymes, and Vitamin B6 may
also help. Ice is also
anti-inflammatory and direct, on-the-skin ice massage is quite effective.