From the Guidelines
Carpal tunnel syndrome should be treated with surgical intervention, specifically carpal tunnel release, for persistent or severe cases that do not respond to conservative treatment after 6-12 weeks, as it provides significant symptom relief and improvement in functional status, as evidenced by the most recent and highest quality study 1.
Treatment Options
The treatment options for carpal tunnel syndrome can be divided into conservative measures and surgical intervention.
- Conservative measures include:
- 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 (400-600mg every 6-8 hours) or naproxen (220-440mg twice daily) to manage pain and inflammation
- Corticosteroid injections, such as methylprednisolone (20-40mg) mixed with lidocaine, to provide temporary relief for moderate symptoms
- Activity modifications, including taking frequent breaks from repetitive hand movements, maintaining proper ergonomics at workstations, and avoiding activities that worsen symptoms
- Physical therapy exercises focusing on nerve gliding and wrist strengthening
Surgical Intervention
For persistent or severe cases that do not respond to conservative treatment after 6-12 weeks, surgical release of the transverse carpal ligament (carpal tunnel release) may be necessary.
- This procedure increases space in the carpal tunnel, relieving pressure on the median nerve and typically providing permanent relief.
- The choice between endoscopic and open release should be based on individual patient factors, as both methods are about as effective as each other in relieving symptoms and improving functional status, although endoscopic release may have functional benefits over open release with regards to return to work and improved grip strength, as suggested by the evidence 1.
Importance of Early Treatment
Early treatment is crucial, as prolonged nerve compression can lead to permanent nerve damage and muscle weakness.
- The most recent and highest quality study 1 supports the use of surgical intervention for persistent or severe cases, highlighting its effectiveness in relieving symptoms and improving functional status.
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 treatment may be offered initially to patients with mild to moderate carpal tunnel syndrome, including:
- Local corticosteroid injection can provide relief for more than one month and delay the need for surgery at one year 2
- 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, 6
Surgical Treatment
- Endoscopic and open techniques are equally effective, but patients return to work an average of one week earlier with endoscopic repair 2
- Surgical treatment has a superior benefit in symptoms and function at six and twelve months compared to conservative treatment 6
Comparison of Treatment Options
- Both splinting and splinting plus local corticosteroid injection have significant effects on the improvement of symptoms, functional, and nerve conduction status 3
- Surgical intervention is more effective than non-surgical treatment for carpal tunnel syndrome, with a larger treatment benefit at six months for functional status and symptom severity 6