From the Guidelines
Conservative management options for carpal tunnel syndrome should prioritize wrist splinting, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, and activity modifications, as these approaches have been shown to reduce inflammation, decrease pressure on the median nerve, and improve blood flow to the area. According to a recent study published in the BMJ in 2021 1, surgery was more effective in most outcome measures compared to non-surgical treatment, which included wrist splinting, steroid injection, or hand therapy. However, conservative management is still a viable option for mild to moderate cases. Some key conservative management options include:
- Wrist splinting in a neutral position, especially at night, to reduce pressure on the median nerve
- NSAIDs such as ibuprofen or naproxen to reduce inflammation and pain
- Corticosteroid injections into the carpal tunnel to provide temporary relief
- Activity modifications, such as taking frequent breaks from repetitive hand movements and maintaining neutral wrist positions during activities These approaches should be tried for 6-12 weeks before considering surgical options, as they can be effective in reducing symptoms and improving functional status, as suggested by the study 1. It's also important to note that endoscopic and open release are about as effective as each other in relieving symptoms and improving functional status, although endoscopic release may have functional benefits over open release, as indicated by the study 1. Overall, conservative management options should be prioritized for mild to moderate cases of carpal tunnel syndrome, with surgery considered for severe symptoms or persistent symptoms despite conservative treatment.
From the Research
Conservative Management Options for Carpal Tunnel Syndrome
- The conservative management options for carpal tunnel syndrome (CTS) include lifestyle modifications, nighttime splinting, and corticosteroid injections 2.
- Splinting and splinting plus local corticosteroid injection are two commonly used conservative options for the management of CTS, with both methods showing significant effects on the improvement of symptoms, functional, and nerve conduction status 3.
- A systematic review found that conservative treatments such as splinting, oral drugs, injections, electrotherapy, specific manual techniques, and neural gliding exercises can relieve symptoms and improve functional ability in patients with mild-to-moderate CTS 4.
- Another 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 5.
- A Cochrane review found that splinting may provide little or no benefits in symptoms in the short term, but may have a higher rate of overall improvement in the short term with night-time splinting 6.
Treatment Effectiveness
- The effectiveness of conservative treatment in patients with CTS regardless of the level of severity and the presence or not of systemic diseases has been reviewed, with some pharmacological treatments, manual therapy, and electrotherapy showing benefits 5.
- A study found that splinting plus corticosteroid injection has a little edge over splinting alone during the follow-up periods 3.
- Another study found that electrotherapy and manual therapy could 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 that includes lifestyle modifications, nighttime splinting, and corticosteroid injections 2.
- 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.
- The use of splinting, oral drugs, injections, electrotherapy, specific manual techniques, and neural gliding exercises can be considered as part of the conservative management of CTS 4.