From the Guidelines
Surgical treatment, specifically carpal tunnel release, is the most effective option for relieving symptoms and improving functional status in patients with carpal tunnel syndrome, as evidenced by the most recent and highest quality study 1.
Treatment Options
Treatment options for carpal tunnel syndrome range from conservative approaches to surgical intervention. For mild to moderate cases, the following options can be considered:
- 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, directly into the carpal tunnel to provide temporary relief for several weeks to months
- Physical therapy focusing on nerve gliding exercises and ergonomic modifications to workstations to help reduce pressure on the median nerve
Surgical Intervention
For persistent or severe symptoms, surgical treatment called carpal tunnel release is recommended, which involves cutting the transverse carpal ligament to relieve pressure on the median nerve 1. This can be performed as an open procedure or endoscopically, with most patients experiencing significant improvement. Recovery typically takes several weeks to months, with grip strength gradually returning. Early treatment is important as prolonged nerve compression can lead to permanent nerve damage and muscle weakness in the hand.
Key Considerations
- Endoscopic release may have functional benefits over open release, including improved grip strength and faster return to work, but may also increase the risk of nerve injury 1
- Surgical treatment has been shown to relieve symptoms significantly better than non-surgical treatment, but is associated with more complications 1
From the Research
Treatment Options for Carpal Tunnel Syndrome
- Conservative treatments, such as wrist splinting and steroid injections, are effective for the relief of carpal tunnel symptoms, but their use remains controversial because they only offer long-term relief in a minority of patients 2
- Immobilization of the wrist in a splint is the most effective, initial method of conservative treatment of carpal tunnel syndrome, with advantages including availability, low cost, good patient tolerance, simplicity, and minimal incidence of complications 3
- Wrist splinting is most effective in cases of minimal or intermediate lesions with distal latency of abductor pollicis brevis-compound muscle action potential less than 8 milliseconds 4
Steroid Injections
- Steroid injections into the carpal tunnel can be effective in relieving symptoms of carpal tunnel syndrome, with significant reductions in pain and disability scores 5
- The effects of proximal and distal approach to the carpal tunnel regarding steroid injection application are comparable, with no significant difference between the two groups 5
- Corticosteroid injection can provide long-term benefits for some patients, with 32 percent of patients not receiving subsequent treatment after a single injection 6
Prognostic Indicators
- Symptom duration of less than 3 months and absence of sensory impairment at presentation are predictive of a lasting response to conservative treatment 2
- Injectate volume and rheumatoid arthritis are significant prognostic indicators for subsequent treatment after corticosteroid injection for carpal tunnel syndrome 6