From the Guidelines
Surgical release of the transverse carpal ligament, either through open or endoscopic techniques, is the most effective treatment for carpal tunnel syndrome, especially for persistent or severe cases, as it has a high success rate in relieving pain and preventing further nerve damage 1.
Treatment Options
Treatment for carpal tunnel syndrome can be divided into conservative and surgical approaches. Conservative treatments are typically recommended for mild to moderate cases and include:
- Wrist splinting, particularly at night
- Activity modifications to avoid aggravating positions
- Over-the-counter anti-inflammatory medications like ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily)
- Physical therapy exercises focusing on nerve gliding and stretching to help reduce symptoms
Surgical Intervention
For cases where conservative treatments do not provide relief, or for persistent or severe cases, surgical intervention is often necessary. The primary surgical option is the release of the transverse carpal ligament, which can be performed through:
- Traditional open surgery
- Endoscopic techniques with smaller incisions Surgery has been shown to be more effective than non-surgical treatments in relieving symptoms and improving functional status, although it may be associated with more complications 1.
Choosing the Best Approach
The choice of treatment depends on the severity of symptoms, duration of the condition, and the presence of nerve damage. Early treatment is crucial to prevent permanent nerve damage and muscle weakness. While endoscopic release may offer functional benefits over open release, such as quicker return to work and improved grip strength, the decision between the two surgical techniques should be made based on individual patient needs and preferences, as well as the surgeon's expertise 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
- Surgery is the definitive treatment for carpal tunnel syndrome, and 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 3
- Conservative treatment may be offered initially to patients with mild to moderate carpal tunnel syndrome, and options include splinting, corticosteroids, physical therapy, therapeutic ultrasound, and yoga 3
- Local corticosteroid injection can provide relief for more than one month and delay the need for surgery at one year 3
- Acupuncture may be an effective treatment for carpal tunnel syndrome, and has been shown to improve symptoms and electrodiagnostic findings in patients with mild to moderate carpal tunnel syndrome 4
- Pharmacotherapy, such as NSAIDs, local and systemic corticosteroids, diuretics, and pyridoxine, may be used to relieve symptoms of carpal tunnel syndrome, but surgery is superior to conservative therapies for most persistently symptomatic patients 5
Recommendations for Treatment
- A course of nonsurgical treatment is an option in patients diagnosed with carpal tunnel syndrome 6
- Early surgery is an option with clinical evidence of median nerve denervation or when the patient so elects 6
- Local steroid injection or splinting is suggested before considering surgery 6
- Carpal tunnel release is recommended as treatment, and surgical treatment of carpal tunnel syndrome by complete division of the flexor retinaculum is recommended 6