Carpal Tunnel Syndrome

Development of Carpal Tunnel Syndrome

Repeated unilateral stress (for example, typing, prolonged mouse use, hammering, etc.) causes inflammation in the tendons, they swell, and compress the nerve fibers running between them (median nerve).

The median nerve runs from the cervical spine through the shoulder and elbow to the wrist. It also provides innervation to much of the forearm flexor and hand muscles. Certain conditions—such as diabetes, rheumatoid arthritis, or thyroid dysfunction—increase the risk of developing tunnel syndrome.

The hand is innervated by three nerves.

• The median nerve (nervus medianus) supplies the palm side of the thumb, index, and middle fingers, as well as their distal phalanges,
• The ulnar nerve (nervus ulnaris) innervates the ring and little fingers,
• The radial nerve (nervus radialis) runs to the back of the hand for the thumb, index, and middle fingers.

We speak of tunnel syndrome when the median nerve is compressed. When this nerve is squeezed, numbness appears in the thumb, index, and middle fingers.

At first it occurs only during the day for short periods, but later also at night, until the numbness becomes constant.

Treatment of Carpal Tunnel Syndrome

Treatment of carpal tunnel syndrome is usually conservative, aiming to reduce inflammation. However, these measures may not always succeed, and surgical intervention may become necessary.

The first and most important step in treatment is to relieve the strain—stop the activities that led to tendon overuse (whether in sports or at work).

For newly arisen wrist pain, cooling can be helpful. Gel ice wraps that conform to the joint are best. If using regular ice, place a towel between the ice and your skin. Leaving ice directly on the skin for half an hour can cause frostbite! Cooling provides the strongest pain relief when the skin temperature drops by at least 15 °C within 10–15 minutes.

At the same time, nonsteroidal anti-inflammatory drugs (NSAIDs) may be used. If your pain does not subside within 2–3 days of cooling, stop, as excessive cooling can slow the healing process.

TENS Therapy

The electrical impulses of TENS devices can be applied for pain relief. Place one electrode 3–5 cm above and one below the painful area and treat. If your device has a modular TENS program, use it; if not, you can choose the conventional or endorphin programs. TENS is a symptomatic treatment: while it relieves pain, it does not affect healing.

Microcurrent Therapy

Microcurrent therapy is performed similarly to TENS, with the difference that microcurrent not only relieves pain but also regenerates the membranes of diseased, inflamed cells, effectively reducing inflammation and stimulating healing.

Ultrasound Therapy

The ultrasound beam raises the temperature of the treated tissues, accelerates circulation, and thus speeds up the healing process. Always use contact gel for ultrasound treatment. Move the transducer slowly in circular motions over the painful area. Read my article on ultrasound dosing.

Low-Level Laser Therapy for Tunnel Syndrome

Direct the laser beam at the carpal tunnel and keep it there until you deliver 5 J of energy to the painful area. Different lasers require different treatment times—refer to the device manual! Laser energy penetrates deep into tissues, stimulating healing, and effectively reducing pain and inflammation. Recommended device: Personal Laser L400

Magnetic Field Therapy

Pulsed magnetic field therapy generated by electricity is effective for any joint or tendon condition—including carpal tunnel syndrome.

Note: static magnets (bracelets, necklaces, straps, belts, etc.) that do not use electricity have no medically proven effect.

Study: Weintraub MI, Cole SP. A randomized controlled trial of the effects of a combination of static and dynamic magnetic fields on carpal tunnel syndrome. Pain Med. 2008 Jul-Aug;9(5):493-504. doi: 10.1111/j.1526-4637.2007.00324.x. PMID: 18777606.

If these anti-inflammatory conservative treatments fail, or if nerve conduction velocity is significantly reduced (as confirmed by ENG/EMG tests), surgical treatment by a hand surgeon may be considered.