The “PRICE” concept (Protect, Rest, Ice, Compress, Elevate) is effective in healing CTS, especially in the initial stages. Protect: Use a wrist cock-up splint to ensure a neutral wrist position. Rest: Avoid/Modify fast repetitive motion, at least for a short time. Ice: Rub ice directly over the carpal tunnel. Compress: Use an elastic wrist band. Exercise: Do wrist exercises at home.
Healthcare providers tend to agree that in non-emergency situations, patients with conditions like Carpal Tunnel Syndrome (CTS) should try non-surgical treatments before consulting with a surgeon.
The “PRICE” concept, that is Protect, Rest, Ice, Compress, and Elevate can be applied to most injuries, including CTS, especially in the acute/inflammatory stage. However, many of these principles also apply in the chronic stage (more than three months) of CTS.
For the Carpal Tunnel Syndrome patient, many doctors commonly prescribe a wrist cock-up splint to be worn overnight, which may surprise some of you! During the day, depending on the type of work you do, a wrist splint can actually get in the way and result in increased symptoms, and at times, cause bruising at both ends of the splint (mid-forearm and mid-hand).
The primary reason to use the splint at night is that one cannot control the position of their wrist during sleep, and it can often wind up bent. This increases the pressure inside the carpal tunnel up to six to eight times more than normal, potentially causing enough pain and tingling to disturb sleep.
The splint guarantees a neutral wrist position, which significantly improves sleep quality and allows healing to occur.
The use of a splint allows the swollen median nerve to heal. However, in order to allow the wrist to rest so that inflammation can subside and the condition can fully heal, patients often need to modify their daily activities, at least for a short time. This may require job restrictions, especially if the occupation involves a fast repetitive motion type of tasks and/or forceful gripping.
The use of an “ice cup” or an ice cube held with a washcloth to protect the fingertips from getting cold is by far the most effective approach. Rub the ice directly on the skin over the carpal tunnel so that you experience the four stages of cooling: Cold, Burning, Aching, and Numb (C-BAN).
This usually takes about four minutes, and it’s important to stop when numbness occurs, as the next stage of cooling is frostbite. This can be repeated multiple times a day and is often as effective as cortisone shots with fewer side effects (and less pain!).
The wrist cock-up splint can offer some compression, but an elastic carpal tunnel wrist band will not usually interfere with most activities of daily living. Some versions include a thumb loop to keep the wrist band in place, but that may get in the way. A version without the thumb loop also works very well.
Exercises performed at home and work can significantly help manage the condition. (Note: For injuries like a sprained ankle, E typically stands for “Elevate”, though it’s not practical for the CTS patient.)