What is the treatment for carpal tunnel syndrome?

Treatment of Carpal Tunnel Syndrome

For carpal tunnel syndrome, surgical treatment is more effective than non-surgical options for long-term symptom relief, though conservative management should be attempted first in mild to moderate cases 1.

Initial Assessment and Diagnosis

• Classic symptoms: Pain, paresthesia, and sometimes weakness in the median nerve distribution 2
• Physical examination findings:
  • Provocative maneuvers: Phalen test and Tinel sign (variable sensitivity/specificity) 2
  • Thenar atrophy (highly specific but late finding) 2
• Electrodiagnostic studies: Useful to confirm diagnosis in atypical cases, exclude other causes, and determine severity for surgical prognosis 2

Treatment Algorithm

1. Mild to Moderate CTS (No objective weakness or sensory deficits)

First-line conservative treatments:

• Wrist splinting:

  • Night-only splinting is as effective as continuous wear 2
  • Neutral wrist position splints are more effective than extension splints 2
  • Should be maintained for at least 3 months in moderate cases 3

• Corticosteroid injections:

  • Provide greater symptom improvement than splinting at 6 weeks, with similar outcomes at 6 months 2
  • Local injections may improve symptoms for longer periods than oral steroids 4
  • One methyl prednisolone injection is commonly used for moderate CTS 3

Ineffective treatments (avoid):

• Over-the-counter NSAIDs and acetaminophen have not shown benefit 2
• Pyridoxine and diuretics are no more effective than placebo 4

2. Severe CTS (With objective weakness or sensory deficits)

• Surgical decompression should be offered immediately 2
• Both endoscopic and open carpal tunnel release techniques are equally effective 2

Treatment Outcomes Based on Symptom Duration

• <6 months: Symptoms typically reduce to normal in a short period after treatment 5
• 6-12 months: Reduced or delayed recovery of hand function 5
• >12 months: Incomplete recovery of grip strength and longest time to return to normal function (median: 16 weeks) 5

Special Considerations

• Pregnant women: Should be treated conservatively as spontaneous postpartum resolution is common 4
• Patients with risk factors: May have slower recovery with conservative treatment (22% improvement at 6 months vs. 30% in those without risk factors) 3

Key Points to Remember

• Only about 10% of patients have a lasting response to conservative treatment alone
• Surgical intervention is highly effective for severe cases and should not be unnecessarily delayed
• Patients who delay surgical treatment may experience incomplete symptom relief and prolonged recovery time 5
• Early intervention leads to better outcomes, especially in severe cases