What are the risk factors and management options for Carpal Tunnel Syndrome (CTS)?

From the Guidelines

Carpal tunnel syndrome (CTS) risk factors include repetitive hand movements, pregnancy, diabetes, rheumatoid arthritis, obesity, hypothyroidism, and genetic predisposition, and management options involve a combination of lifestyle modifications, splinting, and in severe cases, surgical intervention. When considering the management of CTS, it is essential to identify the underlying risk factors to provide effective care. The risk factors for CTS can be categorized into:

• Repetitive hand movements
• Pregnancy
• Diabetes
• Rheumatoid arthritis
• Obesity
• Hypothyroidism
• Genetic predisposition Initial management involves wrist splinting, particularly at night, which keeps the wrist in a neutral position to reduce pressure on the median nerve, as suggested by the American College of Radiology in their 2023 update on chronic hand and wrist pain 1. For patients with chronic wrist pain and normal or indeterminate radiographs, US or MRI without IV contrast may be appropriate as the next imaging study when there is concern for CTS, providing equivalent alternatives for effective patient care 1. Over-the-counter pain medications like ibuprofen or naproxen can help manage pain and inflammation, while corticosteroid injections provide temporary relief for moderate symptoms. In severe cases, surgical decompression through carpal tunnel release is highly effective, with success rates of 75-90%. Ergonomic workplace modifications, including proper positioning of keyboards and mice, regular breaks from repetitive tasks, and stretching exercises, are crucial for prevention and management. Physical therapy focusing on nerve gliding exercises and strengthening can also be beneficial in managing CTS.

From the Research

Risk Factors for Carpal Tunnel Syndrome

• Obesity 2
• Monotonous wrist activity 2
• Pregnancy 2, 3
• Genetic heredity 2
• Rheumatoid inflammation 2
• Trauma 3
• Repetitive maneuvers 3
• Certain diseases 3
• Frequent flexion of the wrist 4
• Frequent extension of the wrist 4
• Frequent sustained forceful motion of the wrist 4
• Use of hand-held, powered, vibratory tools 5
• Repeated and forceful movements of the hand and wrist 5

Management Options for Carpal Tunnel Syndrome

• Non-surgical treatments:
  • Wrist splinting 2, 3
  • Change of working position 2
  • Medications 2
  • Use of alternative non-vibrating equipment at work 2
  • Lifestyle modifications, including decreasing repetitive activity and using ergonomic devices 3
  • Cock-up and neutral wrist splints 3
  • Oral corticosteroids 3
  • Local corticosteroid injections 3
• Surgical treatments:
  • Open release 2, 3
  • Endoscopic surgeries 2, 3