Non-Surgical Treatment of Carpal Tunnel Syndrome
For patients with mild to moderate carpal tunnel syndrome symptoms, non-surgical therapy is considered a reasonable first option with successful outcomes ranging from 20% to 93%. Although there are many non-operative treatments, only three have been shown to effective, and supported by scientific studies:
Carpal Tunnel Wrist Splint
A carpal tunnel wrist splint or a wrist brace holds the wrist in a neutral position, preventing flexion and extension of the wrist. Wrist splinting may limit activities that raise pressure within the carpal tunnel. Splinting is can be effective in reducing carpal tunnel syndrome symptoms, and it may delay or eliminate the need for surgery in mildly symptomatic patients. Wrist splints or wrist braces are usually worn at night, but can be worn continuously. Splints can be purchased over the counter or be custom made by a hand therapist (occupational therapist certified in hand therapy).
Steroid injection into the carpal tunnel is used to reduce tissue inflammation and aid recovery. Steroid injections are effective in reducing symptoms of carpal tunnel syndrome for one to three months when compared with placebo. Steroid injections are associated with several risks, including worsening of median nerve compression, accidental injection into the median or ulnar nerves, and digital flexor tendon rupture. Steroid injections for carpal tunnel syndrome should be limited to once every four months. For patients who have recurrent symptoms after one or two injections, I suggest other nonsurgical treatments or surgery. For more detailed information, see steroid injections.
Oral steroids are effective for short-term improvement of carpal tunnel syndrome symptoms, however, less so than steroid injection. In a placebo-controlled trial that evaluated patients with mild to moderate carpal tunnel syndrome, two weeks of oral prednisone was associated with significant improvement in symptoms, but the benefit gradually waned over eight weeks.