From the Guidelines
Carpal tunnel syndrome treatment should start with conservative approaches, including wrist splinting and physical therapy, before considering surgical intervention, as surgery has been shown to relieve symptoms significantly better than non-surgical treatment, but is associated with more complications 1.
Treatment Options
- Conservative approaches:
- Wrist splinting, particularly at night, to keep the wrist in a neutral position and reduce pressure on the median nerve
- Over-the-counter pain medications like ibuprofen (400-800mg three times daily) or naproxen (220-500mg twice daily) to manage pain and inflammation
- Corticosteroid injections, such as methylprednisolone (20-40mg) mixed with lidocaine, directly into the carpal tunnel for temporary relief
- Physical therapy exercises focusing on nerve gliding and stretching to improve symptoms and function
- Surgical intervention:
- Carpal tunnel release surgery, involving cutting the transverse carpal ligament to relieve pressure on the median nerve, which can be done through traditional open surgery or endoscopic techniques
- Recovery taking several weeks to months
Additional Considerations
- Workplace modifications like ergonomic keyboards, proper positioning, and regular breaks from repetitive activities are important complementary measures
- These treatments work by either reducing inflammation around the median nerve or creating more space in the carpal tunnel to alleviate compression of the nerve, which causes the numbness, tingling, and weakness characteristic of this condition
- According to a recent study, 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 the open release with regards to return to work and improved grip strength 1
From the Research
Treatment Options for Carpal Tunnel Syndrome
The treatment options for carpal tunnel syndrome can be divided into conservative and surgical methods.
- Conservative treatments include:
- Wrist splinting: Immobilization of the wrist in a neutral position or slightly extended at 0-15 degrees can provide therapeutic effects in all patients, regardless of the stage of the carpal tunnel syndrome 2.
- Steroid injections: Steroid injections and wrist splinting are effective for relief of carpal tunnel syndrome symptoms but have a long-term effect in only 10 percent of patients 3.
- Surgical treatments include:
- Open carpal tunnel release: Surgery is the definitive treatment for carpal tunnel syndrome 3.
- Endoscopic carpal tunnel release: Endoscopic carpal tunnel release may give patients a faster recovery compared with traditional open release, but there are no ultimate differences in outcome among the various surgical options 4.
Effectiveness of Treatment Options
The effectiveness of these treatment options varies:
- A study found that 43% of patients were successfully treated with splint treatment alone, and patients successfully treated with wrist splinting alone reported a higher level of satisfaction with their treatment 5.
- Another study found that splints worn at night more than tripled the likelihood of reporting overall improvement at the end of four weeks of treatment compared to no treatment 6.
- However, there is insufficient evidence regarding the effectiveness and safety of one splint design or wearing regimen over others, and of splint over other non-surgical interventions for CTS 6.
Recommendations for Treatment
Based on the studies, it is recommended that:
- Selected patients (i.e., with no thenar wasting or obvious underlying cause) presenting with mild to moderate carpal tunnel syndrome receive either a single steroid injection or wear a wrist splint for 3 weeks 3.
- Wrist splinting as a first-line treatment in the Primary Care setting, and referral to specialist hand and wrist clinics should be reserved for patients with symptoms refractory to this initial measure 5.