How to treat carpal tunnel syndrome?

From the Guidelines

Carpal tunnel syndrome should be treated with a combination of conservative measures, and in severe cases, surgical intervention, prioritizing surgical treatment for significant symptom relief, as evidenced by the most recent and highest quality study 1. The treatment approach for carpal tunnel syndrome involves a multi-step process, starting with conservative measures to alleviate symptoms and prevent further injury.

• Resting the affected wrist and avoiding activities that worsen symptoms is crucial in the initial stages of treatment.
• Wearing a wrist splint, especially at night, helps maintain the wrist in a neutral position, reducing pressure on the median nerve.
• Over-the-counter pain medications, such as ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg twice daily), can help reduce inflammation and pain.
• Corticosteroid injections into the carpal tunnel may be recommended by a healthcare provider for more significant relief.
• Physical therapy exercises focusing on nerve gliding and wrist strengthening can improve symptoms and function.
• Ergonomic modifications at work or home, such as adjusting keyboard height or using ergonomic tools, are essential for preventing symptom recurrence. If conservative treatments fail after 6-12 weeks or if nerve damage is evident, surgical release of the carpal tunnel, either through open or endoscopic procedure, is necessary, as it has been shown to relieve symptoms significantly better than non-surgical treatment, although with more complications 1. The choice between open and endoscopic release should be based on the individual patient's condition and the surgeon's expertise, considering that endoscopic release may have functional benefits, such as improved grip strength and quicker return to work, but also carries a higher risk of nerve injury compared to open release 1. Ultimately, the goal of treatment is to reduce pressure on the median nerve, addressing the fundamental cause of numbness, tingling, and pain characteristic of carpal tunnel syndrome.

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, 3, 4
  • Corticosteroids 2, 5, 6, 4
  • Physical therapy 2, 5, 3
  • Therapeutic ultrasound 2
  • Yoga 2, 3
• Local corticosteroid injection can provide relief for more than one month and delay the need for surgery at one year 2, 4
• 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, 5, 4
• Endoscopic and open techniques are equally effective for surgical decompression, but patients return to work an average of one week earlier with endoscopic repair 2

Factors Influencing Treatment Outcome

• Symptom duration of less than 3 months and absence of sensory impairment at presentation were predictive of a lasting response to conservative treatment 4
• Patients with mild to moderate carpal tunnel syndrome may respond well to conservative therapy and do not need surgery 4

Ineffective Treatments

• Nonsteroidal anti-inflammatory drugs, diuretics, and vitamin B6 are not effective therapies for carpal tunnel syndrome 2, 6