Carpal tunnel syndrome is very common and can cause pain, numbness, tingling, weakness, and muscle atrophy in the hand. Symptoms are due to the median nerve being squeezed in a space in the wrist caused by anything that makes this space smaller and puts pressure on the nerve. Fractures, thickening of tissues, and inflammation are common factors that play a role in narrowing of the carpal tunnel. Carpal tunnel syndrome is linked to traumatic injuries, overuse, congenital abnormalities, and systemic conditions like diabetes, obesity, autoimmune diseases, and even pregnancy. 

Carpal tunnel syndrome is relatively easy to diagnose as patients usually have very consistent symptoms. Usually, no advanced medical testing is needed and carpal tunnel syndrome can be diagnosed based off of simple orthopedic testing. Carpal tunnel syndrome is usually treated conservatively and rarely requires surgery. After treating any underlying conditions that may be causing or exacerbating symptoms, the management of carpal tunnel syndrome is very simple and many people see great results with conservative management. 

Treatment and Management

ACTIVITY MODIFICATION: 

Although this may sound obvious, avoiding or modifying activities that exacerbate symptoms is the first thing you should do to manage carpal tunnel syndrome (1). A good reference for proper ergonomics to avoid exacerbation of symptoms can be found here.

EXERCISE & MOBILIZATION:

Nerve and soft tissue exercise and mobilization techniques are commonly performed in-office by chiropractors or physiotherapists. The techniques consist of active (patient performs) and passive (doctor performs) movements with nerve and tendon "gliding" exercises. These mobilization therapies have been shown to have significantly better short-term effects than surgery (2), and make a great addition to a comprehensive management protocol of immobilization and therapeutic ultrasound (3).

THERAPEUTIC ULTRASOUND & LASER:

Therapeutic ultrasound and low-level laser are two common modalities used to improve inflammatory symptoms and healing time. Therapeutic ultrasound is more common and the positive effects are likely due to its ability to apply heat deep inside of the body and improve blood flow and healing. The use of therapeutic ultrasound and laser have been shown to be as effective as mobilization techniques in improving carpal tunnel syndrome (4). 

YOGA:

The benefits of yoga have been shown to go far beyond the management of carpal tunnel syndrome, but yoga has also shown positive results for this too (5).

ACUPUNCTURE:

Overall, acupuncture is usually great for anything that causes pain or discomfort. Carpal tunnel syndrome is no different. Studies have found acupuncture to be more effective than steroid injections (6), oral steroids (7), and NSAIDs (8) in the reducing the symptoms of carpal tunnel syndrome. 

CHAMOMILE OIL (TOPICAL):

Topically applied chamomile oil has been shown in a small double-blind randomized placebo-controlled trial to significantly improve symptoms and function in individuals with carpal tunnel syndrome (9). A new larger study also showed improvements in not only subjective symptom relief, but also improved function in more rigorous testing (10). 

Many active and passive therapeutic modalities have been shown to be effective for carpal tunnel syndrome. There is not one single way to manage the symptoms conservatively as many methods have been shown to work and the treatments are constantly evolving. This article was an overview of common treatments that have been supported by research and effectiveness varies on an individual basis.