From the Guidelines
Surgical release of the transverse carpal ligament, either through open or endoscopic approaches, is the most effective treatment for carpal tunnel syndrome, especially for persistent or severe symptoms, as it provides significant relief and improvement in functional status, although endoscopic release may have a functionally significant benefit over open release for improvement in grip strength 1.
Treatment Options
Treatment for carpal tunnel syndrome can be divided into conservative and surgical approaches. Conservative management includes:
- Wrist splinting, particularly at night, to keep the wrist in a neutral position
- Over-the-counter pain medications like ibuprofen (400-800mg three times daily) or naproxen (220-500mg twice daily) to reduce inflammation and pain
- Corticosteroid injections, such as methylprednisolone (20-40mg) mixed with lidocaine, for temporary relief
- Activity modifications, including taking frequent breaks from repetitive hand movements, adjusting workstation ergonomics, and avoiding activities that worsen symptoms
- Physical therapy exercises focusing on nerve gliding and wrist strengthening
Surgical Intervention
For patients with persistent or severe symptoms, surgical intervention is often necessary. The two main surgical approaches are:
- Open carpal tunnel release
- Endoscopic carpal tunnel release Both approaches have been shown to be effective in relieving symptoms and improving functional status, with some evidence suggesting that endoscopic release may have a functionally significant benefit over open release for improvement in grip strength 1. However, endoscopic release may also increase the risk of nerve injury compared to open release.
Choosing the Best Approach
The choice of treatment depends on symptom severity, duration, and the presence of nerve damage, which can be assessed through nerve conduction studies 1. Early treatment is crucial to prevent permanent nerve damage. Surgical treatment has been shown to relieve symptoms significantly better than non-surgical treatment, although it is associated with more complications 1.
Key Considerations
- The GRADE quality of the evidence for carpal tunnel syndrome treatment ranges from very low to low 1
- The AMSTAR scores for the meta-analyses reviewed ranged from 7 to 11, indicating moderate to high quality 1
- No randomised controlled trials compared carpal tunnel decompression with placebo or no treatment 1
From the Research
Treatment Options for Carpal Tunnel Syndrome
The treatment options for carpal tunnel syndrome (CTS) can be divided into conservative and surgical methods.
- Conservative treatment includes:
- Pharmacotherapy: The use of NSAIDs, local and systemic corticosteroids, diuretics, and pyridoxine to relieve symptoms 2.
- Local corticosteroid injection: Injection of corticosteroids into the carpal tunnel to reduce pressure on the median nerve 3.
- Splinting: Immobilization of the wrist in a neutral position or slightly extended at 0-15 degrees to reduce pressure on the median nerve 4.
- Activity modification: Avoiding activities that exacerbate symptoms and modifying work habits to reduce strain on the wrist.
- Surgical treatment:
- Surgery is considered for patients who do not respond to conservative treatment or have severe symptoms 2.
Efficacy of Treatment Options
Studies have shown that:
- Local corticosteroid injection provides greater clinical improvement in symptoms one month after injection compared to placebo 3.
- Local corticosteroid injection provides significantly greater clinical improvement compared to oral steroid up to three months after treatment 3.
- Splinting combined with the use of a nonsteroidal anti-inflammatory drug and steroid injection into the carpal tunnel resulted in significant improvement in CTS 5.
- Immobilization in an orthosis gives therapeutic effects in all patients, regardless of the stage of the carpal tunnel syndrome 4.
Comparison of Treatment Approaches
Comparing different treatment approaches:
- A study found that steroid injection from a distal approach (palmar) into the carpal tunnel is comfortable, easy, effective, and an alternative to other methods 6.
- Another study found that there were no statistically significant differences in the treatment results between individual and traditional orthoses, or between rigid and soft orthoses 4.