Alternatives to Surgery for Carpal Tunnel Pain

Alternatives to Surgery for Carpal Tunnel Pain

Some evidence suggests that around 5 percent of Americans suffer from carpal tunnel syndrome, though it’s difficult to arrive at a definitive number. Some people just work through the agony and never visit a doctor. The physiology of carpal tunnel pain is not complex.

The carpal tunnel is a passageway on the underside of the wrist through which nerves and tendons that control thumb and finger movement pass. The passageway is small, and when it gets inflamed through a process like overuse or rheumatoid arthritis, look out! Pain, numbness, and tingling is the usual result. Our keyboard culture is likely a frequent contributor to the issue. But what if you don’t want surgery? Here are some tips for relief.

Treat the Underlying Disease: Get tests done to see if you have an overall arthritis condition. If so, and you are able to treat that, the carpal tunnel pain might improve as well. From disease-modifying anti-rheumatic drugs to biologics, arthritis treatments are moving forward by leaps and bounds.

Rest Those Hands: If there is any way possible to do so, you might consider giving your hands and wrists a break from their usual activity. A few weeks of reduced activity could be enough to allow the inflammation to subside, which may mean less pain. If you can find a way to permanently reduce the workload on your hands, so much the better.

Wrist Splints: For some people, there is no realistic way to cease doing the movement that causes pain. An alternative approach is to wear a wrist splint either during the day or at night while sleeping. It holds your wrist in a neutral position, reducing some of the stress, at least.

Injections: Cortisone, a steroid, is a powerful anti-inflammatory medicine that can be injected directly into joints troubled by pain and inflammation. While probably not a permanent solution, it can provide magical relief for a period of time lasting from weeks to several months or longer, depending upon the severity of your condition.

Get the Exercises: Doctors and physical therapists have developed a series of exercise to help alleviate carpal tunnel issues. The goal is to keep the wrists limber through various hand stretches performed regularly. Even if you don’t have the problem yet, if your job requires repetitive hand motion, start doing the exercises now!

Take Your Breaks: In this overworked culture, people sometimes don’t take their allotted breaks. To avoid carpal tunnel issues, you need to change this habit. While federal law doesn’t mandate rest breaks, most employers have some sort of arrangement for down time every four hours worked. If you keyboard or use heavy vibrating machinery all day, take your breaks to give your wrists a rest.

Alternatives: Don’t get the impression that the only thing you can do for carpal tunnel issues is rest, take drugs, or have surgery. The entire field of alternative medicine and nutritional supplementation is open to you. Some approaches are acupuncture, chiropractic, magnets, massage, and B6 supplementation. There is little standardized research to prove or disprove these approaches, but it might be worth your while to give them a whirl.

The bottom line with carpal tunnel pain is that it is caused by inflammation, and you need to figure out a way to reduce it. If nothing else works, you can always consider surgery. It is a simple process that widens the carpal tunnel passageway, providing more room for those nerves and tendons to operate. Even though the process has been with us since the 1950s, there is always a risk when you have your body cut open. Only you can make the call whether or not the risk is worth the possible gain.

Research at NYDNRehab

Conference: the 12th World Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM 2018)At: Paris, France
Conference: 22nd European Congress of Physical and Rehabilitation Medicine (ESPRM 2020)At: Belgrade, Serbia

About the Author

Dr. Lev Kalika is clinical director of NYDNRehab, located in Manhattan. Lev Kalika is the author of multiple medical publications and research, and an international expert in the field of rehabilitative sonography, ultrasound guided dry needling and sports medicine Dr. Kalika works with athletes, runners, dancers and mainstream clients to relieve pain, rehabilitate injuries, enhance performance and minimize the risk of injuries. His clinic features some of the most technologically advanced equipment in the world, rarely found in a private clinic.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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