Alternatives tocarpal tunnel surgery

There may be non-surgical ways to relieve your carpal tunnel syndrome symptoms.

Self care   

Get the correct diagnosis

Carpal tunnel syndrome can be easily misdiagnosed, your GP is best placed to help you with the diagnosis and any tests or referrals. Similar symptoms may be caused by other conditions, most commonly a problem with your neck. Nerves travelling down to your hand may be compressed at the point in your neck where they leave your spine.

So if you have symptoms in your arm and/or neck as well as your hand, it might not be a carpal tunnel problem and carpal tunnel surgery won’t fix it.

A careful physical examination can often identify where the problem lies, but if there’s any doubt, a neurologist can do a test called an electromyogram (EMG) or nerve conduction study to find out.

Avoid repetitive activity

It was thought that repetitive movements are a cause of carpal tunnel syndrome, but that association is now less clear. Avoiding repeated movement that involves your wrist and hand is unlikely to beneficial. Likewise, changes to your computer desk height to avoid strain from repetitive hand movements does not really help.

Elevate your hand and forearm at night

Sleeping with your hand and forearm on a pillow can help to relieve the symptoms.

Hot and cold therapy

If you’ve recently done something to aggravate your wrist, put an ice pack on it or soak it in a bucket with ice for 10 to 15 minutes. Do this once or twice an hour. If you have chronic pain, try using a heat pack instead.

Exercise

Exercise is not very helpful in relieving the symptoms of carpal tunnel syndrome.

Wear a splint

Wearing a wrist splint at night may help relieve symptoms. The splint keeps your wrist in a neutral position and stops you curling it inwards, which can make symptoms worse. You can wear the splint during the day too if it helps.

You can get wrist splints from pharmacies, but your doctor or physio may recommend having one custom-made. You may be able to claim towards the cost of a wrist splint, depending on your level of cover.

TENS machine

TENS stands for Transcutaneous (through the skin) Electrical Nerve Stimulation. It’s a little battery-operated device with electrodes you stick onto your skin. It generates a small electric current that gives a tingling sensation. You can control the strength and type of current.

It’s not known exactly how TENS works but it may help with carpal tunnel symptoms, although there is little quality research supporting its use. You can find TENS machines at pharmacies, and a physiotherapist can show you how to position it. You may be able to claim towards the cost of a TENS machine, depending on your level of cover.

Medications

Steroids

Painkillers like paracetamol and anti-inflammatory analgesics like ibuprofen or diclofenac aren’t very useful for carpal tunnel syndrome. Instead, your doctor may refer you to a rheumatologist for a steroid injection, or a radiologist for an ultrasound-guided steroid injection. There is a small risk of infection from the injection (1 in 10,000), but the injection works quickly, and relief can be for up to 8 weeks after which the injection may be repeated. If the symptoms do not resolve after repeated injections surgery may be the next best option to consider.

A short course of steroid tablets have been used but placebo-controlled trials have shown them to be ineffective and therefore they’re no longer recommended for use.

Gabapentin

A medication for nerve pain called gabapentin (Neurontin®) has also been shown as ineffective in placebo-controlled trials and shouldn’t be used. Possible side effects including dizziness, drowsiness, dry mouth and tiredness.

Physiotherapy

Physical therapies like exercise and ultrasound have proven to be of little benefit. The benefit of massage is unknown but is unlikely to be helpful. Kinesiotaping has been proven to be ineffective. Some physiotherapists may use magnetic therapy, but there is no evidence to support its effectiveness.

Osteopathy

Osteopaths treat carpal tunnel syndrome using manipulation techniques, but there’s a lack of evidence of its effectiveness.

Acupuncture

An acupuncturist inserts thin needles into your skin, which are thought to stimulate your body’s natural painkilling chemicals. Because the needles are so thin, it’s not usually painful. However, placebo-controlled trials have shown that it’s ineffective in treating carpal tunnel syndrome.

Make sure your acupuncture practitioner is qualified and registered with the Australian Acupuncture and Chinese Medicine Association.

Note: If you have extras cover, you may be able to claim for consultations with physiotherapists, osteopaths and acupuncturists.