From the Guidelines
Treatment for carpal tunnel syndrome should prioritize surgical intervention, specifically carpal tunnel release, for patients with persistent or severe symptoms that do not respond to conservative treatment after 6-12 weeks, as it has been shown to relieve symptoms significantly better than non-surgical treatment 1.
Initial Treatment Approaches
Initial treatment for carpal tunnel syndrome typically includes:
- Wrist splinting, particularly at night, to keep the wrist in a neutral position and reduce pressure on the median nerve
- Over-the-counter pain medications such as ibuprofen (400-800mg three times daily) or naproxen (220-500mg twice daily) to manage pain and inflammation
- Activity modifications, including taking frequent breaks from repetitive hand activities, adjusting computer workstations for proper ergonomics, and avoiding positions that excessively flex or extend the wrist
- Corticosteroid injections (typically methylprednisolone 20-40mg with lidocaine) into the carpal tunnel can provide temporary relief for moderate symptoms, usually lasting several weeks to months
- Physical therapy exercises focusing on nerve gliding and stretching may also help
Surgical Intervention
For patients with persistent or severe symptoms that do not respond to conservative treatment after 6-12 weeks, carpal tunnel release surgery is recommended as it has been shown to relieve symptoms significantly better than non-surgical treatment 1. This procedure cuts the transverse carpal ligament to relieve pressure on the median nerve and can be performed as an open or endoscopic procedure with generally good outcomes. Early treatment is important as prolonged nerve compression can lead to permanent nerve damage and muscle weakness.
Comparison of Surgical Techniques
While both endoscopic and open release techniques are effective in relieving symptoms and improving functional status, endoscopic release may have functional benefits over open release with regards to return to work and improved grip strength, although it may increase the risk of nerve injury 1. However, the quality of evidence for these findings is generally low, and more research is needed to fully understand the comparative effectiveness of these techniques.
From the Research
Treatment Options for Carpal Tunnel Syndrome
- Conservative treatment options are available for carpal tunnel syndrome (CTS), including lifestyle modifications, nighttime splinting, and corticosteroid injections 2
- Studies have shown that splinting and splinting plus local corticosteroid injection can be effective in improving clinical and nerve conduction findings in patients with CTS 3
- A systematic review of randomized controlled trials 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 4
Effectiveness of Traditional Conservative Treatment Techniques
- A systematic review and meta-analysis found that traditional conservative treatment techniques such as manual therapy, massage, and acupuncture can significantly reduce symptom severity, functional status, pain levels, and improve sensory nerve conduction velocity in patients with mild-to-moderate CTS 5
- A literature review found that conservative treatment methods for CTS, including acupuncture, extracorporeal shock wave therapy, hydrodissection, kinesiotaping, corticosteroid injection, low level laser therapy, splints, platelet-rich plasma injection, manual therapy, ultrasound, and phonophoresis, are safe but their effectiveness differs 6
Surgical Treatment
- Carpal tunnel release should be performed in patients in whom nonsurgical treatment fails and patients who have acute CTS secondary to infection or trauma or have advanced symptoms 2
- Recalcitrant CTS, which may occur in as many as 25% of patients who undergo carpal tunnel release, most commonly results from an incomplete transverse carpal ligament release or an incorrect initial diagnosis 2