From the Guidelines
Carpal tunnel syndrome should be treated with surgical options like carpal tunnel release if conservative treatments fail after 6-12 weeks, as surgery has been shown to relieve symptoms significantly better than non-surgical treatment, despite being associated with more complications 1.
Treatment Overview
Carpal tunnel syndrome is a condition where the median nerve is compressed as it passes through the carpal tunnel in the wrist, causing pain, numbness, and tingling in the hand and fingers. Treatment typically begins with conservative measures including:
- Wrist splinting 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
- Activity modification, such as taking frequent breaks from repetitive hand movements, maintaining proper ergonomics at workstations, and avoiding activities that worsen symptoms
Surgical Options
For more severe cases, corticosteroid injections into the carpal tunnel can provide temporary relief. If conservative treatments fail after 6-12 weeks, surgical options like carpal tunnel release may be necessary to cut the transverse carpal ligament and relieve pressure on the median nerve. According to a recent study, open and endoscopic releases for carpal tunnel syndrome 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.
Key Considerations
Early intervention is crucial as prolonged nerve compression can lead to permanent nerve damage and muscle weakness. The decision to proceed with surgery should be based on the individual patient's symptoms, medical history, and response to conservative treatments. It is essential to weigh the potential benefits of surgery against the risks of complications, such as nerve injury, and to discuss these risks with the patient before making a decision.
From the Research
Carpal Tunnel Syndrome Overview
- Carpal tunnel syndrome (CTS) is a focal compressive neuropathy of the median nerve at the level of the wrist, and it is the most common type of compressive neuropathy that occurs in the upper extremity 2.
- Patients with CTS typically have paresthesia, pain, and numbness in the radial three and one-half digits, with nighttime symptoms being more common earlier in the disease process 2.
Symptoms and Diagnosis
- Nighttime symptoms are more common earlier in the disease process, with daytime symptoms becoming more frequent as CTS progresses 2.
- Electrodiagnostic studies may be performed to confirm a diagnosis of CTS or to obtain a baseline before surgical treatment, but they may be normal in a subset of patients who have CTS 2.
Treatment Options
- Patients who have mild CTS should undergo an initial trial of nonsurgical treatment that includes lifestyle modifications, nighttime splinting, and corticosteroid injections 2.
- Carpal tunnel release should be performed in patients in whom nonsurgical treatment fails and patients who have acute CTS secondary to infection or trauma or have advanced symptoms 2.
- Splinting and corticosteroid injections are two of the most commonly used conservative options for the management of CTS, and studies have shown that they can be effective in improving clinical and nerve conduction findings 3.
- A systematic review found that pharmacological treatments, manual therapy, and electrotherapy have shown benefits for handling CTS, although the most effective combination of techniques is unknown 4.
Effectiveness of Conservative Treatment
- A literature review found that the conservative treatment methods for CTS, including acupuncture, extracorporeal shock wave therapy, hydrodissection, kinesiotaping, corticosteroid injection, low-level laser therapy, splints, platelet-rich plasma injection, manual therapy, ultrasound, and phonophoresis, have varying levels of effectiveness 5.
- A systematic review found that splinting may provide little or no benefits in symptoms in the short term, but may have a higher rate of overall improvement in the short term when used at night-time only 6.
Comparison of Treatment Options
- A randomized controlled trial found that splinting plus local corticosteroid injection had a little edge over splinting alone in improving symptoms, functional, and nerve conduction status 3.
- A systematic review found that splinting may not provide additional benefits in symptoms or hand function when given together with corticosteroid injection or with rehabilitation 6.