What are the treatment options for carpal tunnel syndrome?

From the Guidelines

Surgical decompression, specifically carpal tunnel release, is the most effective treatment for carpal tunnel syndrome, particularly for severe or persistent cases, as it provides permanent relief by reducing pressure on the median nerve. Treatment options for carpal tunnel syndrome range from conservative approaches to surgical intervention. For mild to moderate symptoms, conservative approaches such as wrist splinting, particularly at night, to keep the wrist in a neutral position, can be effective 1. Over-the-counter pain medications like ibuprofen (400-800mg three times daily) or naproxen (220-500mg twice daily) can reduce inflammation and pain. Corticosteroid injections, such as methylprednisolone (20-40mg) mixed with lidocaine, can provide temporary relief for several weeks to months. Activity modifications are important—take frequent breaks from repetitive hand movements, adjust workstation ergonomics, and avoid positions that worsen symptoms. Physical therapy exercises that focus on nerve gliding and wrist strengthening may help some patients.

Key Considerations

• For severe or persistent cases not responding to conservative treatment after 6-12 weeks, surgical decompression (carpal tunnel release) may be necessary, as it has been shown to relieve symptoms significantly better than non-surgical treatment, although it is associated with more complications 1.
• The choice between open and endoscopic techniques for carpal tunnel release should be based on individual patient needs and preferences, as both techniques have been shown to be effective in relieving symptoms and improving functional status, although endoscopic release may have functional benefits over open release with regards to return to work and improved grip strength 1.
• It is essential to note that most common elective orthopaedic interventions, including carpal tunnel decompression, are not backed up by readily available high-quality evidence, mostly owing to a lack of definitive randomised controlled trials, highlighting the need for further research in this area 1.

From the Research

Treatment Options for Carpal Tunnel Syndrome

• Conservative treatment may be offered initially to patients with mild to moderate carpal tunnel syndrome, including options such as:
  • Splinting 2
  • Corticosteroids 2, 3
  • Physical therapy 2
  • Therapeutic ultrasound 2
  • Yoga 2
• Local corticosteroid injection can provide relief for more than one month and delay the need for surgery at one year 2
• A comparative study found that splinting plus local corticosteroid injection has a little edge over splinting alone in improving symptoms, functional, and nerve conduction status 3
• Traditional conservative treatment techniques, such as manual therapy, massage, and acupuncture, can significantly reduce symptoms, improve functional status, and improve sensory nerve conduction velocity in patients with mild-to-moderate carpal tunnel syndrome 4
• A literature review found that conservative treatment methods, 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 5
• A systematic review and meta-analysis found that splinting may provide little or no benefits in symptoms in the short term, but may improve hand function in the short term, and may not improve hand function in the long term 6

Surgical Treatment

• Patients with severe carpal tunnel syndrome or whose symptoms have not improved after four to six months of conservative therapy should be offered surgical decompression 2
• Endoscopic and open techniques are equally effective, but patients return to work an average of one week earlier with endoscopic repair 2