What are the treatment options for carpal tunnel syndrome?

Treatment Options for Carpal Tunnel Syndrome

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

Initial Conservative Management

Conservative treatment options should be considered for mild to moderate carpal tunnel syndrome:

• Wrist splinting in a neutral position is a first-line conservative treatment that can provide symptomatic relief, especially when worn at night 2, 3
• Local corticosteroid injections can provide relief for more than one month and may delay the need for surgery for up to one year 2
• Therapeutic ultrasound may provide symptomatic relief for some patients with mild to moderate symptoms 2
• Physical therapy and yoga have shown some benefit in symptom management for mild cases 2

Ineffective Treatments

Some commonly used treatments lack evidence of effectiveness:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) have not been shown to be more effective than placebo 2, 3
• Diuretics show no significant benefit over placebo in symptom relief 2, 3
• Vitamin B6 (pyridoxine) supplementation is not effective for carpal tunnel syndrome 2, 3

Corticosteroid Injection Techniques

• Local corticosteroid injections can be administered using either classic or novel approaches:
  • The classic approach uses a larger needle (25 gauge) proximal to the wrist crease 4
  • A novel approach using a smaller needle (29 gauge) distal to the wrist crease has comparable effectiveness with less procedure time and potentially less pain 4

Surgical Management

Surgery is indicated for:

• Patients with severe carpal tunnel syndrome 1, 2
• Patients whose symptoms have not improved after 4-6 months of conservative therapy 2

Surgical options include:

• Open carpal tunnel release - traditional approach with direct visualization 1, 5
• Endoscopic carpal tunnel release - equally effective as open release for symptom relief, but allows patients to return to work approximately one week earlier 1, 2, 5

Special Considerations

• Pregnancy-related carpal tunnel syndrome should be treated conservatively as spontaneous resolution often occurs postpartum 3
• Occupational carpal tunnel syndrome is relatively uncommon, and other causes (particularly intrinsic factors like obesity) should be excluded before attributing symptoms to occupation 5

Diagnostic Confirmation

• Electrodiagnostic studies are the gold standard for confirmation and should be obtained before surgical intervention to determine severity and surgical prognosis 2, 5
• Ultrasound may be used to measure median nerve size in patients with clinical symptoms 1