From the Guidelines
Carpal tunnel syndrome treatment should start with conservative approaches, including wrist splinting, pain management with ibuprofen or naproxen, activity modifications, and physical therapy, before considering surgical options like carpal tunnel release surgery, as surgery has been shown to relieve symptoms significantly better than non-surgical treatment, although it is associated with more complications 1.
Conservative Treatment
Conservative treatment approaches for carpal tunnel syndrome include:
- Wearing a wrist splint at night to keep the wrist in a neutral position, reducing pressure on the median nerve
- Over-the-counter pain medications like ibuprofen (400-800mg three times daily) or naproxen (220-500mg twice daily) to manage pain and inflammation
- Activity modifications, such as taking frequent breaks from repetitive hand movements, improving ergonomics at the workstation, and avoiding activities that worsen symptoms
- Physical therapy exercises that focus on nerve gliding and wrist strengthening
Surgical Treatment
If conservative treatments fail after 6-12 weeks, surgical options like carpal tunnel release surgery should be considered, which cuts the transverse carpal ligament to relieve pressure on the median nerve. According to a recent study, surgical treatment was shown to relieve symptoms significantly better than non-surgical treatment, although it was associated with more complications 1.
Comparison of Surgical Techniques
The study also compared endoscopic and open release techniques, finding that they are about as effective as each other in relieving symptoms and improving functional status, although endoscopic release may have functional benefits over open release for improvement in grip strength 1. However, endoscopic release may increase the risk of nerve injury compared with open release.
Recommendation
Based on the most recent and highest quality evidence, surgical treatment, specifically carpal tunnel release surgery, is recommended for patients who have failed conservative treatment, as it has been shown to provide significant symptom relief, despite being associated with more complications 1.
From the Research
Treatment Options for Carpal Tunnel Syndrome
- Conservative treatment options for carpal tunnel syndrome (CTS) include splinting, corticosteroid injections, and traditional conservative treatment techniques such as manual therapy, massage, and acupuncture 2, 3, 4, 5, 6
- A study comparing the effectiveness of splinting and splinting plus local corticosteroid injection found that both methods have significant effects on improving symptoms, functional, and nerve conduction status, with splinting plus corticosteroid injection having a slight edge over splinting alone 2
- A systematic review of randomized controlled trials found that diuretics, pyridoxine, non-steroidal anti-inflammatory drugs, yoga, and laser-acupuncture seem to be ineffective in providing short-term symptom relief, while steroid injections seem to be effective, and there is conflicting evidence for the efficacy of ultrasound and oral steroids 3
- A systematic review and meta-analysis found that traditional conservative treatment techniques such as manual therapy, massage, and acupuncture can significantly reduce symptoms, improve functional status, and improve sensory nerve conduction velocity in patients with mild-to-moderate CTS 4
- A literature review found that 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, are very safe, but their effectiveness differs 5
- A survey of certified hand therapists found that patient education, nocturnal orthosis, and ergonomic modifications are among the top conservative interventions utilized for CTS, while treatments such as magnet therapy, C-TRAC, and heating lamps are among the least utilized interventions 6
Effectiveness of Treatment Options
- The effectiveness of conservative treatment options for CTS varies, with some studies finding significant improvements in symptoms and functional status, while others find conflicting evidence or limited effectiveness 2, 3, 4, 5
- Corticosteroid injections seem to be effective in providing short-term symptom relief, while traditional conservative treatment techniques such as manual therapy, massage, and acupuncture can provide significant reductions in symptoms and improvements in functional status 2, 3, 4
- The decision-making process for selecting CTS interventions is influenced by clinical expertise, research evidence, and patient preferences 6
Commonly Used Interventions
- Patient education, nocturnal orthosis, and ergonomic modifications are among the most commonly used conservative interventions for CTS 6
- Splinting and corticosteroid injections are also commonly used treatments for CTS 2, 3, 5
- Traditional conservative treatment techniques such as manual therapy, massage, and acupuncture are also used to treat CTS, although their effectiveness may vary 4, 5