From the Guidelines
Surgical intervention, specifically carpal tunnel release, is the most effective treatment for Carpal Tunnel Syndrome (CTS) in terms of relieving symptoms and improving functional status, as evidenced by the findings of a 2021 umbrella review of level 1 evidence published in the BMJ 1. The treatment plan for CTS typically begins with conservative measures, including:
- 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 such as ibuprofen or naproxen to manage pain and inflammation
- Activity modifications, including taking frequent breaks from repetitive hand activities, improving ergonomics at workstations, and avoiding positions that aggravate symptoms
- Physical therapy exercises focusing on nerve gliding and stretching However, if conservative treatments fail after 6-12 weeks, or if there is evidence of severe nerve compression or muscle wasting, surgical intervention may be necessary. The 2021 review found that open and endoscopic releases for CTS are about as effective as each other in relieving symptoms and improving functional status, although endoscopic release may have a functionally significant benefit over open release for improvement in grip strength 1. It is essential to note that surgery was more effective in most outcome measures compared to non-surgical treatment, including wrist splinting, steroid injection, or hand therapy, as shown in the selected randomized controlled trials 1. Ultimately, the decision to proceed with surgical intervention should be based on the individual patient's symptoms, response to conservative treatment, and overall health status.
From the Research
Treatment Options for Carpal Tunnel Syndrome (CTS)
- Conservative treatment may be offered initially to patients with mild to moderate carpal tunnel syndrome, including options such as:
- Splinting
- Corticosteroids
- Physical therapy
- Therapeutic ultrasound
- Yoga
- Nonsteroidal anti-inflammatory drugs, diuretics, and vitamin B6 are not effective therapies 2
- Local corticosteroid injection can provide relief for more than one month and delay the need for surgery at one year 2, 3
- 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
Effectiveness of Conservative Treatment Techniques
- There is evidence supporting the effectiveness of oral drugs, although injections appear to be more effective 4
- Splinting has been shown to be effective, and it is also associated with use of other non-pharmacological techniques 4
- Assessments of the use of electrotherapy techniques alone have shown no conclusive results about their effectiveness 4
- Traditional conservative treatment techniques, such as manual therapy, massage, and acupuncture, can significantly reduce symptoms and improve functional ability in patients with mild-to-moderate CTS 5
Comparison of Corticosteroid Injections
- Dexamethasone is as effective as triamcinolone in improving the symptoms of CTS and can be used as a safer and more effective alternative in the treatment of mild to moderate CTS cases 6
- Local corticosteroid injection is effective for the treatment of mild and moderate CTS with benefits lasting up to six months and a reduced need for surgery up to 12 months 3
Surgical Decompression
- Endoscopic and open techniques are equally effective, but patients return to work an average of one week earlier with endoscopic repair 2