What is the role of medication and injections?
Anti-inflammatory medication taken by mouth may help reduce the swelling/inflammation within the carpal tunnel. In more involved cases, injection of steroid into the carpal tunnel may help reduce the swelling within the carpal tunnel and take pressure off the nerve. In patients in whom fluid retention is a significant component of the presentation, diuretics to reduce water retention may be of the some value as well. Medications which reduce “nerve” pain may play a role as well.

What is the role of nutritional/dietary intervention?
There is strong anecdotal evidence that vitamin B6 (pyridoxine) in doses of 500 mg per day may help to protect the nerve from some of the damage produced by the excessive pressure. In addition reduction of foods containing high salt content may help to reduce fluid retention, thereby assisting in reducing swelling of the carpal tunnel.

What is the role of surgery?
When symptoms are severe or do not improve with the above measures, surgery may be needed to “open” or “enlarge” the carpal tunnel. Pressure on the nerve is decreased by freeing the ligament which forms the roof of the tunnel on the palmar side of the hand (see right image). Incisions for the surgery may vary, but the goal is the same: To enlarge the tunnel and decrease pressure on the nerve. Following surgery, soreness around the incision may last for several weeks or months. The numbness and tingling may disappear quickly or slowly. It may take several months for strength in the hand and the wrist to return to normal. The patient should consult with their physician or occupational therapist to determine the best treatment strategy post surgery. The occupational therapist and patient can explore those activities, which may possibly aggravate the nerve, so that prevention of recurrence can be minimized.