From the Guidelines
Surgery, specifically endoscopic or open release, is the most effective treatment for carpal tunnel syndrome, particularly for severe or persistent cases, as it provides significant symptom relief and improvement in functional status, despite the potential increased risk of nerve injury with endoscopic release. When considering treatment options, it's essential to weigh the benefits and risks of each approach. According to a 2021 umbrella review of level 1 evidence published in the BMJ 1, endoscopic and open release are about as effective as each other in relieving symptoms and improving functional status. However, endoscopic release may have functional benefits over open release, such as improved grip strength and faster return to work. Some key considerations for treatment include:
- Conservative approaches, such as wrist splinting, pain medications, and activity modifications, can be effective for mild cases or as an initial treatment strategy
- Corticosteroid injections and physical therapy exercises can provide temporary relief and improve symptoms
- Surgery, either endoscopic or open release, is often necessary for severe or persistent cases, with a high success rate and relatively quick recovery time It's crucial to tailor the treatment approach to the individual's symptom severity and response to initial treatments, as recommended by the best available evidence 1.
From the Research
Treatment Options for Carpal Tunnel Syndrome
- Conservative treatment options are available for carpal tunnel syndrome (CTS), including diuretics, pyridoxine, non-steroidal anti-inflammatory drugs, yoga, laser-acupuncture, steroid injections, ultrasound, and oral steroids 2
- A study found that diuretics, pyridoxine, non-steroidal anti-inflammatory drugs, yoga, and laser-acupuncture seem to be ineffective in providing short-term symptom relief, while steroid injections seem to be effective, although with limited evidence 2
- Another study suggested that patients with mild CTS should undergo an initial trial of nonsurgical treatment, including lifestyle modifications, nighttime splinting, and corticosteroid injections, while carpal tunnel release should be performed in patients who fail nonsurgical treatment or have acute CTS secondary to infection or trauma 3
Comparison of Treatment Effectiveness
- A randomized controlled trial compared the effectiveness of splinting and splinting plus local corticosteroid injection in patients with CTS, finding that both methods have significant effects on symptom improvement, but splinting plus corticosteroid injection may have a slight edge over splinting alone 4
- Another study found that local steroid injection and nocturnal wrist splinting were equally effective in treating CTS, but local steroid injection improved objective hand function, resulted in better patient satisfaction, and reduced painkiller use 5
- A systematic review found that pharmacological treatments, manual therapy, and electrotherapy have shown benefits for handling CTS, although the most effective combination of techniques is unknown 6
Treatment Considerations
- The effectiveness of conservative treatment may vary depending on the severity of CTS and the presence of systemic diseases 6
- Electrotherapy and manual therapy may be effective for severe CTS patients with systemic conditions in the short term, but more research is needed to confirm this 6
- Patients with recalcitrant CTS may require additional treatment, such as carpal tunnel release, to alleviate symptoms 3