Over 250,000 Americans every year seek carpal tunnel relief by having surgery. They're part of the 5 million Americans who suffer with the same problem. Most will do just about anything to relieve their crushing numbness, tingling, and pain. And most are advised that surgery is the only answer. But as you'll see, it's not.

So how does this terrible disorder happen? In short, it's due to injured tendons in the wrist.

In the hand, we injure tendons every day simply by using our fingers. Finger pressing, grasping, pinching, twisting, and gripping are all of the actions our flexor tendons are responsible for. If we overwork them (like with too much typing or gripping a hammer) they undergo stress.

That stress produces tiny adhesions and restrictions on the tendons. It prevents them from gliding smoothly.

In normal individuals, stressed tendons repair themselves quickly. The adhesions are stripped away and smooth gliding is restored naturally.

However, in some people the natural tendon repair process is faulty. Performing repetitive and forceful finger or hand movements creates stress that cannot be healed easily by the tendon. This results in tendon swelling and pain called ​repetitive stress injury.

Some people are more prone to getting repetitive stress injury than others. In fact, some occupations are infamous for it. They include:

• Graphic designers
• Dental hygienists
• Transcriptionists
• Hairdressers/stylists
• Video gamers
• Guitar players
• Knitters
• Artists

In some people, the repetitive stress injury is serious. Over the long term, the injury cannot be naturally healed. More importantly, when tendon swelling due to stress occurs in the wrist joint, the result is carpal tunnel syndrome.

The reason this location results in carpal tunnel syndrome is because the swollen tendons are right next to the median nerve. This major nerve of the hand is susceptible to pressure. And that pressure comes from the adjacent swollen tendons.

As the tendons swell more and more, they exert greater pressure on the median nerve. This is what causes all of the unpleasant symptoms of carpal tunnel syndrome.

There are definite signs and symptoms of carpal tunnel syndrome. But before you begin any carpal tunnel relief regimen, make sure you have this condition in the first place.

Why? Because other conditions can mimic it. And you don't want to to waste time and energy on treating carpal tunnel syndrome if you don't actually have it. Those similar conditions are:

• Wrist tendonitis
• Thoracic outlet syndrome
• Rheumatoid arthritis
• Spine misalignment
• Cervical radiculopathy
• Hypothyroidism

The most common symptoms of carpal tunnel syndrome occur in the hand and fingers. The little (pinky) finger is never affected. The symptoms can be short and intense, or long and unrelenting.

When symptoms first start out, you may feel:

• Numbness
• Tingling (pins & needles)
• Pain
• Weakness

In its early stages, these carpal tunnel symptoms only appear during rest. This is why many patients begin waking up at night, with the need to shake out a numb hand.

Some people have other sensations in these hand and finger areas like feelings of puffiness (even though there is no visible swelling), soreness, burning, loss of finger or hand strength, and dexterity problems.

As symptoms advance, they eventually enter the severe stage of carpal tunnel syndrome. This is when symptoms are much more intense and constant. They generally last all day and night, with little or no relief.

In the severe stage, most patients see catastrophic loss of hand strength and dexterity. It's common to hold an object like a drinking glass and feel electric shocks shoot through the hand. Others feel numbness when holding a phone to their ear. Many people feel numbness or pain while driving their car.

In the severe stage, most patients lose the sensation of hot or cold temperatures in their fingertips. This is particularly dangerous because carpal tunnel patients are known to burn their fingers around the kitchen stove.

In it's "end stage", carpal tunnel syndrome usually results in a "claw hand". This is where the fingers are permanently bent or curled. Also, the thumb muscle wastes away, so grasping is nearly impossible.

By this time most patients will have found another occupation. They do not seek employment known to be associated with carpal tunnel syndrome. But such a change is often too late to restore their hand.

According to both the NIH and AAOS, there are several nonsurgical therapies which provide significant carpal tunnel relief in most patients. These are discussed in detail below and include:

• Steroid injections
• Stretching exercises
• Myofascial release massage
• Wrist bracing at night
• Applied heat
• Yoga exercises
• Acupuncture
• Acupressure
• Vitamin B supplements

Perhaps the best-known carpal tunnel relief technique is the steroid injection ("steroid shot"). The injection contains corticosteroid, a powerful anti-inflammatory drug.

The doctor uses a hypodermic needle to inject the drug directly into the carpal tunnel space. The idea is to reduce inflammation and swelling on the tendons. When swelling is relieved, the tendons no longer crush the median nerve. Symptoms should therefore disappear. (That's the hope, at least.)

For those patients who get steroid injections into the carpal tunnel, relief is almost instant -- usually within 24 hours. But in practice, steroid shots are only effective in 45% of patients.

That means a large percentage of steroid shot patients experience either unsatisfactory results or no relief whatsoever. And even if the shots do provide relief, it's not permanent.

Carpal tunnel relief using steroid shots, when they work, last for as little as a few weeks to a few months. Then the symptoms return.

Whether or not the steroid shots work for relieving carpal tunnel syndrome, all patients must consider the side effects. Some are more serious than others. The more dangerous side effects of steroid shots include:

• Difficulty breathing
• Swelling in the face, throat, tongue, gums or lips

There are less dangerous and rarer side effects of steroid injections. They include:

• Injection site swelling and pain
• Restlessness and nervousness
• Increased appetite
• Rapid weight gain
• Nausea, vomiting or stomach pain
• Thirstiness and frequent urination
• Fever or sore throat
• Black or bloody stools
• Muscle weakness, cramps or pain
• Hives, acne or red/purple lines
• Blurred vision

Due to the relatively low effectiveness of steroid shots in providing lasting carpal tunnel relief, and the side effects involved, the AAOS’s advises doctors: 

• To limit steroid shots to only 3 times in a single year. 
• That more than 3 shots in total increases the probability of more severe side effects.
• If 3 shots cannot provide carpal tunnel relief, then discontinue corticosteroid therapy altogether. 

Fast, easy-to-do, simple stretching exercises work wonders for most people with carpal tunnel syndrome. But not just any exercises will do the trick.

The exercises must stretch the flexor tendons which swell and cause carpal tunnel syndrome in the first place. The proper exercises will therefore break apart any adhesions on the tendons. They also lubricate the tendons so they glide smoothly, without restrictions or interruptions.

Happily, the proper tendon stretching exercises take less than a minute to do. If you have mild or moderate symptoms, you should do them every 1-2 hours for maximum benefit.

More severe symptoms require hourly stretching exercises. And severe symptoms usually require additional therapy, like myofascial massage and night bracing (see below).

Carpal tunnel syndrome is a result of injured tendons inside the carpal tunnel space of the wrist joint. The injury produces adhesions and restrictions on the tendon's surface. Those adhesions in turn produce inflammation and swelling.

That swelling is what exerts pressure on the median nerve. The result are all of the unpleasant symptoms of carpal tunnel syndrome.

To permanently relieve those adhesions (and symptoms), it's best to remove them by direct mechanical force. This is something that surgery, steroid shots or other remedies simply cannot do to provide long-term relief.

However, it's exactly what myofascial release massage does. Unlike ordinary manual massage, this form of therapy breaks up adhesions deep under the skin.

Essentially, the therapist "kneads" the skin over the wrist joint. The twisting action transmits below the skin and pushes and pulls on the tendons. This causes adhesions to rip away.

With adhesions gone, swelling dissolves and symptoms disappear. The process is so effective in providing carpal tunnel relief that therapists use it as their "go to" remedy.

Apart from destroying adhesions, myofascial release massage also helps drain excess fluid pressure from inside the carpal tunnel space. Doing so further reduces pressure on the median nerve. 

Another added benefit of myofascial release massage is that it facilitates blood flow to the wrist. This brings needed nutrients to help heal the damaged tendons. It also caries away cellular debris as part of the healing process.

The downside to myofascial release massage is that it must be performed at least daily for one month to see good results. Furthermore, you cannot perform it on yourself because it requires two thumbs. (See myofascial release massage instructions here.) Therefore a skilled partner is needed.

So if you do have a partner to learn the technique and help, you can avoid seeing a therapist every day. And the upside is amazing: most people see carpal tunnel relief within 30 days.

Wrist bracing is both the most common and most misused remedy for carpal tunnel syndrome. When used properly, bracing is simple and effective.

But most people seeking carpal tunnel relief use a wrist brace completely wrong. Here's why...

Many carpal tunnel sufferers wear a wrist brace during the day, while their hand is working. This is like tying you to a chair and asking you to dance!

When you have carpal tunnel syndrome, your wrist tendons are already injured. Stress caused them to weaken and form adhesions. Now you perform your regular daily tasks (like typing, cooking, etc.) which requires your tendons to work.

But if you restrict your hand with a wrist bracer, you're asking your hand to perform double work. In other words, you're requiring your hand to do its regular activity and simultaneously fight the restrictions of the brace.

This double work requirement makes the situation much worse. It only causes your carpal tunnel syndrome to progress further.

Therefore, never wear a wrist brace during the daytime. Instead, wear a brace only when you sleep. Doing so keeps your hand from over-bending, which increases pressure on your median nerve.

Wearing a night brace is highly effective for carpal tunnel relief. But only if symptoms have not advanced too far. Therefore, in the mild or moderate stages of carpal tunnel syndrome, nocturnal bracing is a preferred method of treatment.

You should never wear a generic wrist brace purchased from your local pharmacy. CVS, Walgreen's, and Walmart all sell various wrist braces. Some brace packages even state "for carpal tunnel syndrome". But they're not.

These generic braces all have a metal spine on the palmar surface. If you unconsciously bend your hand backward while you sleep, that spine presses into your wrist joint. Doing so further increases the pressure on your median nerve. More than likely, you'll wake up with even worse symptoms - and that's why.

However, a certified carpal tunnel brace is made for this disorder. In fact, you can tell if it's not really a certified carpal tunnel brace if it has a metal palmar spine. So be careful when purchasing a wrist brace!

Our bodies crave heat. We're warm-blooded because most metabolic processes require heat to work. Actually, heat is so important to our bodies that at rest, most of our caloric intake is applied only to producing heat.

Needless to say, heat is the underlying mechanism which allows the body to heal. Applying heat from an external source (like a heating pad) to an injury frees the body to produce more nutritive chemicals to send to the injured area.

This is why heating pads are so valuable for most injuries, like those from sports or accidents. The injury to tendons due to carpal tunnel syndrome is no different.

But heat alone for good carpal tunnel relief is not enough. While it's very helpful, it must be used in conjunction with other remedies in order to leverage the effects of those other remedies.

For instance, the combination of heat with myofascial release massage is remarkable in that they are more powerful than their sum effects. They amplify each other so that tendon healing occurs quickly and permanently. Tendon inflammation is reduced and they're restored to normal by using heat plus massage.

Of course, more severe cases of carpal tunnel syndrome require more extensive heat and massage therapy than mild cases. But even severe carpal tunnel syndrome is relieved using this combination.

Yoga was once considered by doctors to be "fringe science". But today, yoga is regarded as a complimentary medicine by the NIH. 

When it comes to carpal tunnel relief, yoga exercises are proven by clinical science to reduce symptoms. Today, the science supports what countless unofficial reports (over decades) from carpal tunnel sufferers have claimed. In fact, the Journal of the American Medical Association says yoga should be a first-line nonsurgical treatment for carpal tunnel syndrome.

To be maximally effective, yoga exercises should be performed as part of your daily routine. You perform them until symptoms completely resolve.

A happy added benefit of yoga is it's meditative effects. People with carpal tunnel syndrome usually have severe pain. The meditation provided by yoga helps center the mind, providing a balance that's often disturbed by extreme pain and anguish.

Like yoga, acupuncture was once relegated to the dark corners of "mystery science". But not anymore. Today, acupuncture as a therapy is taught as part of every mainstream medical school's curriculum.

When it comes to carpal tunnel relief, many patients find acupuncture to be highly beneficial. But curiously, some patients see absolutely no benefit whatsoever. And the majority of patients who get acupuncture for carpal tunnel syndrome fall in between these two extremes. Exactly why this happens is not known.

We know from basic physiology that acupuncture unblocks nerve impulses on pathways which control pain. Other science has shown that acupuncture releases pain relieving chemicals.

The major problem in using acupuncture for carpal tunnel relief is that the effects are not long-lasting. Once the acupuncture needles are removed, pain and other symptoms usually return within hours or a day.

Much of acupuncture's effectiveness depends on how long you had carpal tunnel syndrome, its severity, your age, how you use your hands, and if you have any other comorbidities (like diabetes).

Certainly, acupuncture should not be viewed as a permanent carpal tunnel relief option.

The technique of using acupressure for carpal tunnel relief is very similar to acupuncture. But unlike acupuncture, acupressure has few scientific trials to back up its effectiveness.

Actually, the principles of acupressure have more in common with reflexology. It requires using pressure (by the hands and fingers) over specific pressure points. The idea behind this is to stimulate circulation.

Practitioners claim acupressure is effective in relieving carpal tunnel syndrome. But there are no clinical trials or serious studies validating this claim.

And similar to acupuncture, acupressure practitioners say its effects are not long-lasting. This goes for carpal tunnel relief or relief from any other disorder.

The only upside is that acupressure can be self-administered. As most practitioners suggest, if it works for you, then use it!

Taking vitamin B6 supplements for carpal tunnel relief is controversial. But it's worth discussing because of the shear number of sufferers who say it helps them

It all started when clinical data showed that people with carpal tunnel syndrome usually have a vitamin B6 deficiency. So it seemed logical to add vitamin B6 to the diet in the hopes carpal tunnel syndrome would resolve.

Unfortunately, most times that's not the case. Scientific studies show that vitamin B6's effects are not consistent. In other words, vitamin B6 supplements work (to varying degrees) in some people with carpal tunnel syndrome but not in others. This inconsistency is why the NIH does not recommend vitamin B6 as a carpal tunnel therapy.

The upside is that if you take up to 200mg of vitamin B6 supplement per day, it won't cause harm or side effects. And the fact that is helps some people is the reason why doctors usually say, "Give it a try".

Of the 8 most common nonsurgical carpal tunnel relief treatments, some are more effective than others. By far, most will yield superior results compared to carpal tunnel surgery. The better treatments include steroid shots, myofascial release massage, nocturnal wrist bracing, heat therapy, and yoga. Acupuncture, acupressure, and vitamin B6 supplements are less effective, and certainly not long-term solutions.

1) https://pubmed.ncbi.nlm.nih.gov/9820263/

2) https://pubmed.ncbi.nlm.nih.gov/9820263/

3) https://pubmed.ncbi.nlm.nih.gov/9820263/