The primary anatomical “design flaw” of the carpal tunnel is that it is completely enclosed and not very flexible. So if there is any swelling of the tissue within the carpal tunnel it cannot expand to accommodate the swelling and the result is an increase in pressure inside the ligament. This pressure compresses the median nerve, damaging it. Swelling, in turn, can be caused by trauma, repeated use, direct external compression, flexing the wrist, inflammation, edema (water retention in the tissues), and even rarely tumors or masses.
Treatment for CTS is divided into two categories, surgery and conservative (everything other than surgery). Conservative management is almost always tried first and/or in combination with surgery. It consists of removing or avoiding the trauma that is causing the increased pressure in the carpal tunnel, wearing a wrist brace to protect the wrist and avoid hyperflexion, taking anti-inflammatories to treat inflammation (this can either be aspirin-like medications or steroids, which can either be oral or injected), treating edema, and now using the pain relieving device called Reliev-ER. This device will effectively release endorphins into nervous tissues. These released endorphins are three times stronger than morphine. There is some evidence that vitamin B6 may help nerve recovery, but by itself does not address the nerve compression. Also there are a number of symptomatic treatments for the pain, but again these are not curative as they do not address the underlying mechanism of nerve injury.
Conservative treatment usually helps to some degree (largely dependent upon compliance), but is often not sufficient for long-term control of CTS. That’s why the Reliev-ER was developed to provide effective relief for CTS long-term. Nevertheless, when conservative management fails, or is not sufficient, there are a variety of surgical options.
In 1988 the first alternative to open CTR was developed by Dr. Michael G. Brown, who developed the process of endoscopic CTR. This procedure involves a smaller incision in the skin than open CTR and uses small cameras to visualize the transverse carpal ligament to make the proper transection.
There are two situations where there is at least a plausible mechanism for an effect. The first is when there is a more proximal nerve compression – in the neck or shoulder, that is caused or exacerbated by muscle spasm or hypertrophy. This situation is not CTS, but rather a compression of the nerve farther up that can mimic some of the symptoms of CTS. So this really would not be a treatment for CTS, but for another syndrome that can be mistaken for CTS. As an aside, as a neuromuscular expert I can say that a good clinician should not confuse these syndromes, and if there is clinical overlap then a nerve conduction study should be able to sort out the proper diagnosis.