Ways to treat carpal nerve compression without surgery

Finding a non-surgical treatment for carpal tunnel syndrome is an important concern for those with carpal tunnel syndrome. It often starts with inflammation of the hand nerve, then develops into strangulation as a result of several factors, such as excessive stress, incorrect movements, or exposure to an injury in the area, which affects the peripheral nerves and leads to strangulation of the median nerve that connects the wrist to the palm.

What are the symptoms of carpal tunnel syndrome? What are the main causes of this condition? What are the possible complications if treatment is ignored? Can exercises to treat carpal tunnel syndrome help in recovery? Does it require surgical intervention, or can the condition be treated without surgery? These questions and others are answered by the Dalili Medical website in this article.

**What is carpal tunnel syndrome?**

Carpal tunnel syndrome is a medical condition also known as "carpal tunnel syndrome", which causes tingling, pain, numbness, and weakness in the hand and wrist. Nerve strangulation occurs as a result of increased pressure on the median nerve in the wrist, which controls sensation in the thumb, index finger, middle finger, and half of the ring finger, while the little finger (pinky) is usually not affected by this syndrome.

**Why does hand nerve strangulation occur?**

Nerves are damaged by excessive pressure, either through stretching or injuries. Carpal tunnel syndrome is caused by excessive pressure on the median nerve in the hand, which can slow down its function over time. If trauma occurs to the area, the nerve can slow down significantly.

When the nerve is cut, it stops sending signals completely, as signals cannot pass through the gap created by the cut. Nerve stretch injuries range from mild, temporary, to severe, permanent, and the severity of the injury depends on the extent of the stretch. Nerve injuries can occur as a result of overstretching the fingers, hand, or wrist, or as a result of crushing or burning them.

Nerve injuries can also result from accidents, illnesses, or malnutrition, with car accidents, work injuries, and falls being common causes of nerve damage. In addition, some medical conditions, infections, and repetitive use of tools, such as cell phones, can affect the hand and its nerves, leading to pain and damage.

Who is at risk of developing carpal tunnel syndrome?

There are several factors that increase the likelihood of developing carpal tunnel syndrome, the most prominent of which are:

- **Gender**: Women are more likely to develop nerve compression, due to their naturally narrow carpal tunnels.
- **Bone spurs**: Thickening of the bones can lead to the formation of bone spurs that cause stiffness in the spine, which narrows the nerve passages and puts pressure on the nerve.
- **Thyroid dysfunction**: Thyroid dysfunction affects the nerves of the hand and increases the risk of injury.
- **Diabetics**: Diabetics are more likely to develop inflammatory diseases of the nerves.
- **People with jobs that require repetitive hand movements**: such as dentists or manual work such as knitting.
- **Sleeping for long periods in bed**: increases the risk of nerve strangulation. 

What is inside the carpal tunnel?

The carpal tunnel consists of:

- **Tunnel bones**: form a semicircle that forms the bottom and sides.
- **Median nerve and tendons**: located at the top of the tunnel, where the median nerve is responsible for sensation in most of the hand, while the tendons are like ropes and connect the forearm muscles to the bones of the hand, allowing the fingers to bend. 

Is there a treatment for hand nerve strangulation without surgery?

Yes, hand nerve strangulation can be treated without surgery, especially if the condition is in its early stages and has not developed into complications. Treatment includes complete rest, taking some painkillers and anti-inflammatory medications, physical therapy exercises, and it may require cortisol injections around the nerve to relieve inflammation and reduce pressure. 

How do I know if I have hand nerve strangulation?

Attention should be paid to the symptoms that may indicate nerve compression, the most prominent of which are: numbness and tingling in the fingers, a burning sensation and pain in the area, in addition to pinching or scratching in the hand and the palm of the big finger.

What is the carpal tunnel? And what is its relationship to peripheral nerve compression?

The carpal tunnel is a narrow passageway inside the wrist consisting of the wrist bones at the bottom, while the upper part contains the carpal ligament. Nerves and tendons pass through this tunnel, as the median nerve passes to the palm of the hand, and supplies the palm of the hand, thumb, index finger and middle finger, and also supplies some of the internal muscles of the palm with nerve endings.

Is carpal tunnel syndrome dangerous?

If carpal tunnel syndrome is not treated, the possibility of complications and worsening of the problem is high, and it may develop into muscle atrophy and nerve fibrosis. However, prompt treatment and commitment to complete rest can make treatment effective and fruitful.

**Causes of Carpal Tunnel Syndrome (Strangulation of the Hand Nerve)**

Most cases of carpal tunnel syndrome (strangulation of the hand nerve) occur as a result of a combination of factors. Women and older people are more likely to develop this condition.

Other factors that may contribute to the development of carpal tunnel syndrome include:

- **Genetic factors**: play an important role, as the carpal tunnel may be smaller in some individuals or there may be anatomical differences that affect the space available for the nerve, and these characteristics may be passed down through families.

- **Repetitive hand movements**: repeating the same movements of the hand or wrist for long periods can lead to irritation of the tendons in the wrist, causing swelling that puts pressure on the nerve.

- **Hand and wrist position**: performing movements that involve excessive flexion or extension of the hand and wrist for long periods may increase pressure on the nerve.

- **Pregnancy**: hormonal changes during pregnancy may lead to swelling.

- **General health condition**: Some diseases such as diabetes, rheumatic infections, and disorders 

Thyroid gland is associated with carpal tunnel syndrome.

**Symptoms of carpal tunnel syndrome (hand nerve compression)**:

Symptoms include numbness, tingling, burning, and pain, especially in the thumb, index, middle, and ring fingers. The patient may also feel sudden shocks such as heat radiating through the fingers.

The pain and numbness can extend to the forearm and shoulders, causing weakness in the hand and difficulty performing fine movements such as fastening buttons. People may also drop things due to weakness, numbness, or loss of the ability to hold the hand in place.

In most cases, symptoms begin gradually without any obvious injury. Some patients may feel that the symptoms come and go at first, but as the condition worsens, the symptoms may become more frequent or last longer.

Symptoms most commonly appear in the evening, as poor wrist position during sleep can wake the person up. During the day, symptoms may occur when holding something for a long time with the wrist bent, such as using a phone, driving, or reading a book. Some patients find that shaking or moving their hands helps relieve symptoms.

**Recovery after surgery to treat carpal tunnel syndrome (carpal tunnel syndrome):**

After surgery, you will be asked to elevate your hand above the level of your heart and move your fingers to reduce swelling and prevent stiffness. You can expect to feel some pain, swelling, and stiffness after the procedure.

Mild inflammation of the palm of your hand may occur and last for a few weeks or even months in some cases. The ability to grip and pinch usually returns about two to three weeks after surgery.

If your median nerve condition was very bad before surgery, your ability to grip and pinch may not improve for six to twelve months. You may need to wear a wrist or wrist brace for several weeks, but you will be allowed to do some light activities, with caution to avoid some possible complications. You may be allowed to drive, do personal care activities, and lift light weights shortly after surgery. Your doctor will talk to you about when it is appropriate to return to work and whether you should follow any restrictions on your work activities.

**Complications of carpal tunnel syndrome surgery (carpal tunnel syndrome):**

Although complications can occur after any surgery, your doctor will talk to you about how to reduce your risk of these complications. The most common complications associated with carpal tunnel syndrome surgery include:
- Bleeding
- Infection
- Nerve irritation or injury

**Expectations after carpal tunnel syndrome surgery (carpal tunnel syndrome):**

In most cases, surgery will help improve your carpal tunnel syndrome symptoms. Recovery is gradual, and full recovery may take about a year. If you have pain or weakness that lasts longer than two months, your doctor may refer you to a hand physical therapist to speed up your recovery. If you have another condition that causes pain or stiffness in your hand or wrist, such as chronic arthritis or chronic tendinitis, your recovery may be slower. In chronic cases of carpal tunnel syndrome, where there is loss of sensation or muscle weakness at the base of the thumb, recovery may be slower than usual, and you may not recover completely. In some cases, carpal tunnel syndrome may return, although this is rare, and if it does occur, you may need additional treatment or another surgical procedure.

**Stages of nerve impingement:**

The stages of nerve impingement usually consist of three stages:

1. **Stage 1:** Patients feel numbness, pain, and tingling, especially at night, and can relieve symptoms by shaking their hands.

2. **Stage 2:** Symptoms appear during the day when the hands remain in the same position for a long time or when performing repetitive movements, which leads to weakness in the hands and frequent dropping of objects.

3. **Stage 3:** Patients suffer from permanent atrophy of the muscles associated with the median nerve, as the nerve stops sending signals to the brain, resulting in a complete loss of sensation.

**What are the expected results after endoscopic hand nerve decompression?**

After endoscopic hand nerve decompression, carpal tunnel syndrome and its associated symptoms are expected to disappear. However, the recovery period may vary from person to person depending on the patient's health condition. Expected symptoms after the operation:

- Feeling some pain in the incision areas.

- Feeling numbness and tingling in the hands, which may continue for a period after the operation, but it is temporary and disappears after a short period.

**Success rate of endoscopic hand nerve decompression**

The endoscopic hand nerve decompression operation is characterized by high success rates ranging between 75% and 90%. However, achieving the highest success rate depends on several factors, including:

- The competence of the surgeon performing the operation.
- The modernity and quality of the medical techniques used.
- The patient's commitment to the doctor's instructions after the operation.
- The patient's general health condition.

**What are the risks of endoscopic hand nerve decompression?**

Although endoscopic hand nerve decompression is considered a simple and safe operation, it may include some potential risks, such as:

- Leakage of fluids from the surgical incision.
- The appearance of a bad smell from the wound.
- High body temperature.
- Damage to the surrounding tissues.
- Swelling and inflammation of the wound.
- Weakness of the hand muscles.
- Feeling severe pain.
- Risk of infection.

**How ​​can I take care of myself after endoscopic hand nerve decompression surgery?**

After completing the endoscopic hand nerve decompression surgery, the patient must follow a set of tips to avoid complications and speed up recovery from carpal tunnel syndrome. The most important of these tips are:

- Completely avoid activities that require pressure on the wrist, such as writing or lifting heavy objects.
- Avoid carrying heavy weights for at least a week after the operation.
- Commit to taking the recommended medications and painkillers 

Visit your doctor on time.
- Avoid moving your fingers frequently to avoid swelling.
- Keep your hand elevated.

**Carpal tunnel syndrome diagnosis:**

Hand nerve strangulation is diagnosed by:

- Informing your doctor of the symptoms you are experiencing.
- Explaining how the symptoms appear, such as when carrying something or losing sensation in the little finger.
- Performing a physical examination to test sensation in your fingers and the strength of your hand muscles when bending your wrist.
- Using X-rays to rule out arthritis or fractures.
- Performing an electromyography to determine the possibility of muscle damage.
- Nerve conduction testing to rule out other possibilities.

After the diagnosis is completed, non-surgical nerve strangulation treatment is prescribed. If non-surgical treatment does not achieve the desired results, surgical intervention to clear the nerve becomes the available option.

**Carpal tunnel syndrome (hand nerve strangulation) surgically:**

If non-surgical treatments do not succeed in relieving symptoms after a period of time, your doctor may recommend surgical intervention. The decision to perform surgery depends on the severity of the condition and the accompanying symptoms, in addition to the level of pain and numbness you feel in your hand. In chronic cases characterized by persistent numbness and loss of thumb muscles, surgery may be necessary to avoid any permanent damage.

**Steps of surgical intervention to treat carpal tunnel syndrome:**

There are two main methods of surgical intervention to treat carpal tunnel syndrome, as both aim to relieve pressure on the median nerve by removing the ligaments that form the roof of the tunnel, which increases the size of the tunnel and relieves pressure on the nerve. Most carpal tunnel surgeries are performed in equipped clinics, and general or local anesthesia may be used, which affects only the area of ​​the operation. In some cases, sedative medications may be used that are injected through a cannula into a vein.

1. **Open Carpal Tunnel Release:**
In this procedure, the doctor makes a small incision in the palm of the hand to expose the wrist from the inside. During the procedure, the transverse ligaments of the wrist are cut, increasing the size of the tunnel and reducing pressure on the median nerve. After surgery, the ligaments may gradually grow back, but there will still be a larger space in the tunnel, relieving pressure on the nerve.

2. **Endoscopic Carpal Release:**
In this method, the doctor makes one or two small incisions and uses an endoscope to see inside the hand and wrist. The transverse ligaments of the wrist are then cut using a special tool, in a manner similar to open surgery.

**Treatment of right hand nerve strangulation:**

Right hand nerve strangulation is a common condition that can be treated with several non-surgical methods, such as taking anti-inflammatories and nerve vitamins, with the need for complete rest for the affected hand. It is also recommended to undergo physical therapy using ultrasound waves, and relieve pressure on the nerve using fixators during sleep.

In addition, exercises such as lifting, stretching, and controlling fine movements of the fingers can be practiced regularly to improve the condition of the affected organ. Therefore, patients suffering from symptoms of right hand nerve strangulation should not delay treatment and early diagnosis, as effective treatment helps prevent the worsening of symptoms and promotes the restoration of movement and function of the affected organ.

**Treatment of nerve strangulation**

At the International Center for Spine Surgery, we use the best methods to treat nerve strangulation, which include the following options:

**First: Conservative treatment**
Conservative treatment is the most common method for treating nerve strangulation, as it requires rest and avoiding activities that cause pressure on the nerve. In some cases, it may be necessary to use a splint or brace to stabilize the affected area. If this method does not work, we move on to other treatment options.

**Second: Physiotherapy**
Physiotherapy includes sessions supervised by the attending physician, aimed at helping the patient recover.

**Third: Drug therapy**
The medications used in this context include cortisone injections, which are given in the area of ​​​​nerve weakness.

**Fourth: Endoscopic surgical intervention**
This type of operation is performed in equipped clinics under the influence of general anesthesia. Endoscopic surgery has a high success rate, making it the best option for achieving higher recovery rates. You can undergo endoscopic nerve compression surgery at the International Spine Surgery Center, where various surgeries are performed using the latest, safest and most comfortable techniques.

**Electrofunctional Tests**
Nerve conduction studies test nerve conduction and measure nerve signals in the hand and arm, helping the doctor assess the severity of the condition and determine the appropriate treatment.

**Electromyography (EMG)**
This test measures electrical activity in the muscles, and its results indicate the presence of nerve or muscle damage.

**Ultrasound**
This technique is used to create images of bones and tissues, which helps assess the impact of pressure on the median nerve.

**X-rays**
If the wrist movement is limited or the patient is experiencing wrist pain, the doctor may order an X-ray to rule out other possible causes, such as chronic arthritis, ligament damage or fractures.

**Magnetic Resonance Imaging (MRI)**
This test provides detailed images of the soft and smooth tissues of the body. Your doctor may order an MRI to determine other causes of symptoms or to look for abnormal tissue that may be pressing on the median nerve, which helps diagnose any problems with the nerve itself, such as injuries or cancerous tumors.

**Top Tips After Hand Nerve Decompression**
Basic tips after hand nerve decompression include:

- Apply cold compresses to the wrist for 10-15 minutes every two hours for the first three days after the procedure.
- Eat

Take the medication prescribed by your doctor regularly, including painkillers and antibiotics.
- Change the bandage on the wound area as directed by your doctor.
- Avoid getting water on the bandage while showering.
- Practice physical therapy exercises to restore the normal range of motion of the joint and strengthen the hand muscles.
- Avoid excessive pressure on the injured hand for 6 weeks after the operation, by reducing activities that require hand strain such as writing and cutting food.
- Refrain from lifting heavy weights.
- Visit your doctor according to the scheduled follow-up sessions.

**Median Nerve Stretching:** People with hand nerve strangulation often experience tingling and numbness in the thumb and fingers, especially the index and middle fingers. A simple exercise can be performed by placing the palm of the hand on a wall with the fingertips facing away from the body so that they are parallel to the ground. Then, the trunk is rotated away from the wall while keeping the elbow straight, which helps to feel the stretch in the arm and forearm. Then, return to the starting position and repeat the exercise on the other side.

**Radial nerve stretching:** Pain caused by this nerve is manifested by a feeling of numbness and tingling, in addition to pain in the upper arm, elbow, and half of the thumb on the outside. An exercise can be done by connecting the palm of the hand with the palm of the hand while pointing the arms inward and keeping the elbows straight, then raising the hands above the head, then returning to the starting position and repeating the exercise.

**Hand grip exercise:** The fingers are closed to form a fist, and remain in this position for 30 to 60 seconds, then the fingers are opened wide. This exercise is repeated four times or more.

**Finger extension exercise:** The palm of the hand is placed on any table or flat surface, then the fingers are gently extended and straight above the surface without pressing on them. This position is maintained for 30 to 60 seconds, then the hand is released and the fingers are relaxed. This exercise is repeated at least four times for each hand.

**Finger flexion exercise:** The palm of the hand is directed in front of the face, then the fingers are bent so that their bases touch the palm of the hand, making them resemble a claw. This position is maintained for 30 to 60 seconds, then the hand is relaxed.

**Free hand movement exercises:** These include exercises within the full range of motion that aim to increase blood flow to the hand, improve nerve nutrition, and reduce pressure on the median nerve. This is done by moving the hand in all directions with light pressure at the end of the range of motion, and the exercise continues for 5 minutes, taking into account the level of pain.

**Stretching exercises:** Stretching exercises are performed for the neck muscles and the internal muscles of the hand, in addition to the contracted transverse tendon of the hand.

**Nerve mobilization exercises:** Median nerve mobilization exercises help release the nerve and remove the adhesions surrounding it.

**Tendon mobilization exercises:** These exercises aim to move the tendon to different degrees, which contributes to improving hand movement.

**Hand grip strengthening exercises:** These exercises aim to enhance the strength of the hand grip, and a nerve ball can be used as an aid.

**Full arm stretching exercise:** This exercise helps to stretch all the muscles of the arm, which enhances the effectiveness of stretching the tendons of the hand.

**Thumb stretching exercises:** These exercises involve moving the thumb in all directions of movement.

**Finger abduction exercise:** A piece of paper or a stick can be used between the fingers as a means of enhancing movement between them.

**Wrist movement exercise:** This exercise focuses on moving the wrist joint forward and backward in all directions with pressure.

**Body weight wrist press exercise:** This exercise aims to achieve effective stretching of all tendons.

**Instructions before the hand nerve decompression surgery to treat nerve strangulation:**
Before the hand nerve decompression surgery, it is necessary to inform the doctor of all medications you are currently taking. It is recommended to stop taking some blood thinners (such as aspirin). Some laboratory tests, an electrocardiogram, and other necessary tests must also be performed according to your health condition. It is preferable to refrain from eating and drinking for a period ranging from 6 to 12 hours before the operation.

**Traditional method for hand nerve decompression surgery:**
Median nerve decompression surgery is performed under local anesthesia, where the wrist and hand are numbed.

**Steps followed in traditional surgery to treat hand nerve decompression:**
- A surgical incision is made about 2 inches long in the wrist area.
- The doctor cuts the carpal ligament using surgical tools, allowing the carpal tunnel to be widened and pressure on the median nerve to be relieved.

**Steps followed when using an endoscope in nerve decompression surgery:**
- Two small incisions are made, each about half an inch long, one in the wrist area and the other in the palm of the hand.
- A thin, flexible tube containing a small camera is inserted through the surgical incision in the wrist area.
- The camera provides clear, magnified images of the wrist area, allowing the doctor to insert fine surgical tools through the other incision and cut the carpal ligament to free the decompressed nerve.