The goal of treatment is to reduce the pressure on the median nerve by reducing the swelling in the carpal tunnel or cutting the transverse carpal ligament to make more space. In most, initial treatment is nonoperative and consists of activity modification, splinting, and, in some cases, formal therapy. Over-the-counter medications such as anti-inflammatory medications or acetaminophen may reduce symptoms but don’t directly treat the problem.
Cortisone injections have been documented to be effective in relieving symptoms and may result in a cure. In some cases, ultrasound guidance may be used to precisely place the cortisone around the nerve. This procedure may provide superior results in some patients compared to non-ultrasound guided injections. In severe or unresponsive cases, surgery may be necessary to cut the transverse carpal ligament and relieve pressure on the nerve. This is traditionally performed by means of an open surgery or endoscopic surgery, resulting in good or excellent outcomes in the majority of patients. More recently, advanced ultrasound guided procedures have been developed to loosen or even cut the ligament through small incisions, also resulting in excellent results.