What are the treatment options for carpal tunnel syndrome?

Treatment Options for Carpal Tunnel Syndrome

The most effective treatment for carpal tunnel syndrome is surgical decompression, particularly for moderate to severe cases, providing significantly better symptom relief than non-surgical options. 1

Diagnosis Approach

• Carpal tunnel syndrome is diagnosed primarily through clinical evaluation combined with electrophysiologic studies 2
• Ultrasound can be used to measure median nerve size in patients with clinical symptoms 1
• Further imaging is usually not needed, but in selected circumstances, either wrist ultrasound or MRI without contrast may be appropriate 2

Treatment Algorithm

Conservative Management (First-line for mild to moderate cases)

• Wrist splinting in a neutral position is an effective initial treatment option 3
• Local corticosteroid injection provides relief for more than one month and can delay the need for surgery at one year 3
• Additional conservative options include:
  • Physical therapy 3
  • Therapeutic ultrasound 3
  • Yoga 3
• Oral corticosteroids can be effective for short-term management (2-4 weeks) 4
• Treatments proven ineffective (not recommended):
  • Nonsteroidal anti-inflammatory drugs 3, 4
  • Diuretics 3, 4
  • Vitamin B6 (pyridoxine) 3, 4

Surgical Management

• Surgery is indicated for:
  • Patients with severe carpal tunnel syndrome 3
  • Patients whose symptoms have not improved after 4-6 months of conservative therapy 3
  • Cases with clinical evidence of median nerve denervation 5
• Surgical options:
  • Open carpal tunnel release 1, 6
  • Endoscopic carpal tunnel release 1, 6
  • Both techniques are equally effective for symptom relief, but endoscopic repair allows patients to return to work approximately one week earlier 1, 3

Special Considerations

• Pregnant women should be treated conservatively as spontaneous postpartum resolution is common 4
• Wrist immobilization is not recommended postoperatively after routine carpal tunnel surgery 5
• For occupational carpal tunnel syndrome, it's essential to exclude other causes (particularly intrinsic factors such as obesity) before attributing it to occupation 6

Treatment Monitoring

• Instruments such as the Boston Carpal Tunnel Questionnaire and the Disabilities of the Arm, Shoulder, and Hand questionnaire can be used to assess patient responses to treatment 5

Common Pitfalls

• Failure to obtain electrodiagnostic studies before surgical decompression, which are important to determine severity and surgical prognosis 3
• Prolonged conservative management in severe cases with evidence of median nerve denervation, which may lead to permanent nerve damage 5
• Attributing symptoms solely to occupation without excluding other common causes 6