Carpal Tunnel Syndrome

Ergonomic modifications CRITICAL: neutral wrist position when typing (wrist straight, not flexed or extended—use ergonomic keyboard, wrist rest), keyboard and mouse at elbow height, monitor at eye level (prevents neck/shoulder strain that worsens symptoms), frequent breaks (every 30-60 minutes—shake hands out, stretch), avoid prolonged gripping or repetitive hand movements, use tools with larger grips (reduces force needed), Night splinting (most important conservative treatment): wear wrist splint at night in neutral position (prevents wrist flexion during sleep—many people sleep with wrists curled, worsening compression), wear 4-8 weeks minimum, 70-80% improve with night splinting alone, some benefit from daytime splinting during activities that worsen symptoms, Nerve gliding exercises: specific exercises to mobilize median nerve, reduce adhesions, perform 3-5x/day, taught by physical therapist or hand therapist, Avoid: activities that worsen symptoms (prolonged gripping, forceful grasping, vibrating tools, sleeping on hands, extreme wrist flexion/extension), Weight loss if overweight (reduces symptoms), Stress management (stress increases muscle tension, worsens symptoms), Cold therapy (ice wrist for 10-15 min after activities that worsen symptoms—reduces inflammation), Corticosteroid injection into carpal tunnel: if conservative treatment insufficient after 6-12 weeks—provides temporary relief (3-6 months average), allows better participation in PT/ergonomic modifications, can repeat but limited number, 60-70% improve temporarily, Surgery (carpal tunnel release—cut transverse carpal ligament to decompress nerve): for severe carpal tunnel (thenar atrophy, constant numbness, weakness), progressive symptoms despite 6-12 months conservative treatment, positive Phalen's and Tinel's tests, abnormal nerve conduction studies—surgery highly effective (90-95% good outcomes), open or endoscopic approach (endoscopic faster recovery but slightly higher complication rate), risks (infection, nerve damage, scar tenderness, pillar pain, recurrence 5-10%, incomplete release), recovery 4-12 weeks, Many patients avoid surgery with: night splinting (most important), ergonomic modifications, vitamin B6, anti-inflammatory diet/supplements, nerve gliding exercises, corticosteroid injection if needed—worth trying before surgery, Pregnancy-related carpal tunnel: often resolves postpartum (fluid retention decreases)—night splinting, vitamin B6, avoid surgery during pregnancy unless severe.