From the Guidelines
Surgical intervention, specifically carpal tunnel release, is the most effective treatment for carpal tunnel syndrome, particularly when conservative measures fail or symptoms are severe, as it provides significant relief from symptoms and improves functional status 1.
Treatment Overview
Carpal tunnel syndrome is a common condition caused by compression of the median nerve as it passes through the carpal tunnel in the wrist, resulting in numbness, tingling, and pain in the hand and fingers. Treatment should begin with conservative measures, including:
- Wrist splinting 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 (400-600mg every 6-8 hours) or naproxen (220-440mg twice daily) to manage pain and inflammation
- Activity modification, such as avoiding repetitive wrist movements, taking frequent breaks during hand-intensive activities, and maintaining proper ergonomics at workstations
- Corticosteroid injections into the carpal tunnel for temporary relief
- Physical therapy exercises to strengthen and stretch the wrist and hand muscles
Surgical Intervention
If conservative treatments fail after 6-12 weeks or if symptoms are severe with evidence of muscle weakness or atrophy, surgical intervention called carpal tunnel release is necessary, as it cuts the transverse carpal ligament to relieve pressure on the median nerve 1. Both endoscopic and open release are effective in relieving symptoms and improving functional status, although endoscopic release may have functional benefits over open release, such as improved grip strength and faster return to work 1. However, endoscopic release may also increase the risk of nerve injury compared to open release.
Evidence-Based Decision
The decision to proceed with surgical intervention is based on the best available evidence, which indicates that surgery is more effective than non-surgical treatment in relieving symptoms and improving functional status 1. The GRADE quality of the evidence ranges from very low to low, but the majority of reviews suggest that surgical treatment is the most effective option for carpal tunnel syndrome 1. Therefore, surgical intervention should be considered the primary treatment option for carpal tunnel syndrome, particularly when conservative measures fail or symptoms are severe.
From the Research
Carpal Tunnel Syndrome Treatment Options
- Carpal tunnel syndrome (CTS) is a compression neuropathy of the median nerve causing pain, numbness, and tingling in the hand and arm 2.
- Conservative treatment options for CTS include splinting, corticosteroid injections, and lifestyle modifications 3, 2, 4, 5.
Effectiveness of Splinting
- Splinting may provide little or no benefits in symptoms in the short term (< 3 months) compared to no active treatment 6.
- Night-time splinting may result in a higher rate of overall improvement in the short term 6.
- The effectiveness of splinting in the long term (> 3 months) is uncertain 6.
Comparison of Treatment Options
- Splinting plus corticosteroid injection may have a little edge over splinting alone in improving symptoms and functional ability 3.
- Corticosteroid injections may be more effective than oral drugs in treating CTS 4.
- Electrotherapy and manual therapy may be effective for severe CTS patients with a systemic condition in the short term 5.
Treatment Recommendations
- Patients with mild CTS should undergo an initial trial of nonsurgical treatment, including lifestyle modifications, nighttime splinting, and corticosteroid injections 2.
- Carpal tunnel release should be performed in patients who have failed nonsurgical treatment or have acute CTS secondary to infection or trauma 2.
- The most effective combination of conservative treatment techniques is unknown, and further studies are needed to determine the best approach 4, 5.