The median nerve runs along the arm and through the wrist to supply some of the muscle movement and skin sensation in the hand. Median nerve damage most commonly occurs in association with carpal tunnel syndrome, where swollen tissue causes increased pressure on the nerve as it passes through a channel called the carpal tunnel, on the inside of the wrist. As the nerve damage can resolve on its own, doctors may initially recommend wearing a wrist splint during the night and avoiding activities that make the problem worse. Surgery may be carried out if the condition fails to improve. Other types of median nerve damage, which may occur at the level of the forearm or elbow, are less likely to get better by themselves and may be treated using anti-inflammatory drugs and rest, or surgery.
Median nerve treatments aim to relieve symptoms and prevent damage from progressing. In the case of carpal tunnel syndrome, symptoms of pain, tingling and numbness may be experienced in parts of the hand supplied by the nerve. These areas are the thumb, the next two fingers and one side of the ring finger. Symptoms are worse at night and they may disturb sleep. Sometimes the hand muscles become weak, making it difficult to grip objects.
As the median nerve damage resulting from carpal tunnel syndrome can often go away within around six months, doctors may advise non-surgical treatment at first. The condition is more likely to resolve in younger people, who are under the age of 30, in pregnant women suffering from fluid retention, and in people who have the condition in only one hand. Sometimes, diseases such as hypothyroidism can be an underlying cause of carpal tunnel syndrome, and treating such conditions may reduce nerve compression.
If daily activities are triggering symptoms, it may be necessary to change methods of working and introduce more rest periods. At night, a splint can hold the wrist at an angle which helps to protect the median nerve from compression. For some people, steroid tablets may be taken for a few weeks to improve symptoms, but these cannot be taken long term due to side effects. Steroid injections have been found to help the condition for around a month, but after that there is no evidence of benefit.
When non-surgical methods of median nerve treatment fail to provide relief from carpal tunnel syndrome, surgery may be carried out. The operation involves cutting a tissue band, known as a ligament, that forms part of the carpal tunnel. This provides more space inside the tunnel and reduces pressure on the median nerve.