What is the treatment for bilateral carpal tunnel syndrome?

From the Guidelines

Surgical intervention, specifically open or endoscopic carpal tunnel release, is the most effective treatment for bilateral carpal tunnel syndrome, as it provides significant symptom relief and improvement in functional status, despite the potential increased risk of nerve injury with endoscopic release 1. When considering treatment options, it's essential to weigh the benefits and risks of each approach. Conservative measures, such as wrist splinting, pain medications, and activity modification, can be effective in managing mild to moderate symptoms. However, for persistent or severe cases, surgical intervention is often necessary to achieve significant improvement. Some key points to consider when deciding on a treatment plan include:

• The effectiveness of open and endoscopic release in relieving symptoms and improving functional status, with endoscopic release potentially offering functional benefits in terms of return to work and grip strength 1
• The increased risk of nerve injury associated with endoscopic release compared to open release 1
• The importance of assessing symptom severity, duration, and the presence of nerve damage through nerve conduction studies to determine the best course of treatment
• The potential benefits of conservative measures, such as wrist splinting and corticosteroid injections, in managing symptoms and delaying or avoiding the need for surgical intervention In terms of specific treatment options, the following may be considered:
• Open carpal tunnel release, which involves cutting the transverse carpal ligament to relieve pressure on the median nerve
• Endoscopic carpal tunnel release, which is a minimally invasive procedure that may offer faster recovery times and less post-operative pain
• Conservative measures, such as wrist splinting, pain medications, and activity modification, which can be effective in managing mild to moderate symptoms.

From the Research

Treatment Options for Bilateral Carpal Tunnel Syndrome

• Conservative treatment is recommended for mild to moderate cases of carpal tunnel syndrome, while severe cases are usually treated surgically 2, 3.
• Conservative treatments that have shown effectiveness in relieving symptoms and improving functional ability include:
  • Splinting 2, 3
  • Oral drugs, such as gabapentin 4
  • Injections, including local corticosteroid injections 2, 3
  • Electrotherapy 2, 5
  • Manual therapy, including specific manual techniques and neural gliding exercises 2, 5
• Lifestyle modifications, such as decreasing repetitive activity and using ergonomic devices, have been traditionally advocated but have inconsistent evidence to support their effectiveness 3.
• Nonsteroidal anti-inflammatory drugs, diuretics, and pyridoxine (vitamin B6) have been shown to be no more effective than placebo 3.
• The most effective combination of techniques is unknown, and further studies of better methodological quality are needed to determine the best treatment approach 2, 5.

Treatment Effectiveness by Severity

• Conservative treatment has been effective for mild and moderate idiopathic carpal tunnel syndrome 5.
• For severe carpal tunnel syndrome, electrotherapy and manual therapy may be effective in the short term, but more research is needed to confirm this 5.
• Patients with moderate to severe disease should be considered for surgical evaluation 3.

Treatment Safety and Side Effects

• Gabapentin has been found to be partially effective and safe in symptomatic treatment of carpal tunnel syndrome patients, with mild and transient side effects 4.
• Local corticosteroid injections are considered a first-line therapy, but may have side effects such as pain and swelling at the injection site 3.