Avoiding the Scalpel: Lessons from 57 Carpal Tunnel Surgeries So Far This Year
⌚️ read time: 3 minutes
Us hand surgeons…we do a lot of carpal tunnel surgery.
Why?
To put it simply, as common as carpal tunnel syndrome is, there is a narrow range of non-invasive treatment options that have proven successful in alleviating symptoms.
But there is some good news.
Of all the methods you could think of to treat carpal tunnel syndrome, the only ones shown to work (other than surgery) can be done in the comfort of your home. That means no repeat trips to the therapist, chiropractor, or doctor’s office.
If you are waking up with a numb thumb, index finger, middle finger, and/or ring finger (review symptoms and causes of carpal tunnel syndrome here), try these three at-home remedies before considering carpal tunnel release surgery.
Modify any activities requiring prolonged wrist extension or wrist flexion
One thing we know from a nice scientific study done in the 1980s is that any wrist position other than straight (ie, neutral) increases the pressure on the median nerve within the carpal tunnel.
Increased pressure leads to poor oxygen delivery to the nerve, beginning a cycle of injury. This will ultimately lead to carpal tunnel syndrome. Classic symptoms of carpal tunnel syndrome include waking up in the night with a numb thumb, index finger, middle finger, and/or ring finger.
Which is a miserable experience to endure night after night. You’ll be Googling ‘carpal tunnel treatment’ in no time.
So if you find yourself in positions of significant wrist extension or flexion throughout the day (think typing or driving), it would be a high-impact investment to modify your technique.
Simple changes in your posture can make an outsized difference in how your wrist is positioned. ‘Ergonomics’ is the buzzword (I have a whole guide on this here), but it really means changing your environment to allow your anatomy to function the way it was designed.
Don’t underestimate the power small changes can have on the lifetime health of your wrists.
Minimize repetitive hand/wrist tasks
This one is a grey area.
But there is some compelling evidence that the accumulation of repetitive hand and wrist tasks over time leads to a higher rate of carpal tunnel syndrome. We see this most dramatically in construction workers who use a jackhammer, but it is also common in those who work in manufacturing plants or auto repair shops.
Contrary to popular opinion, the evidence linking typing to carpal tunnel syndrome is scant, at best.
If your days involve repetitive tasks with your hands or wrists, it would be worth experimenting with a break or modification to determine any positive effect on your symptoms.
Sleep in a wrist brace every night for 6 weeks
As basic as it seems, this is the most powerful thing you can do if you’re experiencing carpal tunnel symptoms.
Any drugstore wrist brace with a rigid insert that crosses the wrist will do. Compression or neoprene sleeves will not.
If it’s reasonably comfortable and prevents you from flexing or extending your wrist, it’s the correct brace. There’s no need to get caught up in all the marketing nonsense you will inevitably encounter around ‘carpal tunnel braces.’
While bracing doesn’t work for everyone, I urge you to give this one solid committed attempt.
Bracing works for several reasons. The body experiences changes overnight that put the nerve at more risk of compression.
Most important is the fact that when we are in deep sleep, the wrists will typically flex for an extended period of time…thus seriously decreasing median nerve blood flow for hours on end.
A brace will prevent this.
But to reap the benefits, it must be done right.
Wear the brace all night. Wear the brace every night. Do this for a minimum of 6 weeks. If you commit to this, you will have an answer at the end of the 6 weeks.
You either cured your carpal tunnel syndrome (because the cause of your carpal tunnel syndrome was nighttime positioning).
Or you are likely to need surgery (because the cause of your carpal tunnel syndrome is from the roof ligament thickening over time. A summary of this process can be found here).
Takeaways:
True carpal tunnel syndrome rarely improves with therapy, medications, or injections
The good news is that if a non-operative treatment is going to cure your carpal tunnel syndrome, it is likely something you can DIY at home
By far the most effective non-surgical treatment for carpal tunnel is consistent nighttime brace wear for a dedicated period of 6 weeks
Carpal tunnel syndrome can be frustrating as a surgeon who likes to try multiple options for patients before taking them to the operating room.
But the reality is, your most effective options are nighttime bracing…or surgery.
Hopefully this article helps clarify your options and what is best to try before seeing a hand specialist for carpal tunnel syndrome.
