What are the treatment considerations for carpal tunnel syndrome?

From the Guidelines

Treatment for carpal tunnel syndrome typically begins with conservative approaches before considering surgical intervention. Initial management includes wrist splinting, particularly at night, to keep the wrist in a neutral position and reduce pressure on the median nerve. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) can help reduce inflammation and pain. Activity modification is essential, including ergonomic adjustments at work, taking frequent breaks from repetitive activities, and avoiding positions that worsen symptoms. Corticosteroid injections (typically methylprednisolone 20-40mg with lidocaine) into the carpal tunnel can provide temporary relief for moderate to severe symptoms. Physical therapy exercises focusing on nerve gliding and stretching may also help.

Key Considerations

• The choice of treatment depends on symptom severity, duration, and the presence of nerve damage, with the goal of relieving pressure on the median nerve to prevent permanent nerve damage.
• For patients who don't respond to conservative treatment after 6-12 weeks or have severe symptoms with evidence of nerve damage, surgical release of the transverse carpal ligament (carpal tunnel release) is recommended 1.
• This procedure can be performed using open or endoscopic techniques, with most patients experiencing significant improvement.

Treatment Options

• Conservative management: wrist splinting, NSAIDs, activity modification, corticosteroid injections, and physical therapy exercises.
• Surgical management: open or endoscopic carpal tunnel release.

Important Notes

• The treatment approach should be individualized based on the patient's specific needs and circumstances.
• Patients should be informed about the potential benefits and risks of each treatment option, as well as the importance of seeking medical attention if symptoms worsen or persist.

From the Research

Treatment Considerations for Carpal Tunnel Syndrome

• The initial management of carpal tunnel syndrome (CTS) typically involves nonsurgical treatment, including lifestyle modifications, nighttime splinting, and corticosteroid injections 2.
• Patients with mild CTS should undergo an initial trial of nonsurgical treatment, while those with acute CTS secondary to infection or trauma, or advanced symptoms, may require carpal tunnel release 2.
• Conservative management with splinting is often initiated, and patients are advised to reduce activities that exacerbate symptoms 3.
• Nonsteroidal anti-inflammatory drugs and orally administered corticosteroids can be effective for short-term management, but local corticosteroid injection may improve symptoms for a longer period 3.
• Surgical therapy may be considered if symptoms are refractory to conservative measures 3.

Nonsurgical Treatment Options

• Bracing and corticosteroid injections may be useful in the nonsurgical treatment of CTS, although the benefits may be short term 4.
• Other treatments, such as physical therapy, exercise, yoga, acupuncture, lasers, and magnets, have limited evidence regarding their efficacy, and further studies are needed 4.
• A review of treatment methods for CTS includes non-steroidal anti-inflammatory drugs, injection of medications, immobilization by splinting, rehabilitation modalities, and surgery by carpal tunnel release 5.
• Non-surgical treatment, other than steroid injection, for CTS has been evaluated, and the effectiveness of various treatments, such as hand braces, ultrasound, oral medications, and alternative therapies, has been assessed 6.

Effectiveness of Non-Surgical Treatments

• A hand brace has been shown to significantly improve symptoms after four weeks, and function after four weeks 6.
• Ultrasound treatment for two weeks was not significantly beneficial, but one trial showed significant symptom improvement after seven weeks of ultrasound, which was maintained at six months 6.
• Oral steroid treatment has been shown to significantly improve symptoms compared to placebo, while diuretics or nonsteroidal anti-inflammatory drugs did not demonstrate significant benefit 6.
• Yoga has been shown to significantly reduce pain after eight weeks, and carpal bone mobilisation has been shown to significantly improve symptoms after three weeks 6.