From the Guidelines
Evaluation of carpal tunnel syndrome should begin with a clinical evaluation combined with electrophysiologic studies, as further imaging is usually not needed 1. When evaluating patients with suspected carpal tunnel syndrome, a thorough clinical assessment is crucial, including a detailed history and physical examination. Patients should be asked about symptoms like numbness, tingling, or pain in the thumb, index, middle, and radial half of the ring finger, especially at night or with repetitive hand activities.
- Key components of the physical examination include:
- Tinel's sign (tapping over the median nerve at the wrist)
- Phalen's test (holding wrists in flexion)
- Testing for sensory deficits and thenar muscle weakness Electrodiagnostic studies, specifically nerve conduction studies and electromyography, are considered the gold standard for confirming the diagnosis and determining severity 1.
- In selected circumstances, either wrist US or MRI without contrast may be appropriate for further evaluation, but this is not typically necessary 1. It is essential to consider systemic conditions like diabetes, thyroid disease, or rheumatoid arthritis as potential contributing factors and order laboratory tests accordingly.
- A comprehensive evaluation approach allows for accurate diagnosis and appropriate treatment planning, whether conservative management with splinting and anti-inflammatories or surgical intervention for severe cases.
From the Research
Evaluation Recommendations for Carpal Tunnel Syndrome
- The initial management of carpal tunnel syndrome (CTS) should include lifestyle modifications, nighttime splinting, and corticosteroid injections for patients with mild CTS 2.
- A comparative study found that splinting plus local corticosteroid injection may have a slight edge over splinting alone in improving clinical and nerve conduction findings in patients with CTS 3.
- Conservative interventions for CTS may include splinting the wrist in neutral for nocturnal wear, intermittent exercise, and activity modification 4.
- A systematic review of randomized controlled trials found that steroid injections seem to be effective in providing short-term symptom relief, while diuretics, pyridoxine, non-steroidal anti-inflammatory drugs, yoga, and laser-acupuncture seem to be ineffective 5.
- A Cochrane review found that splinting may provide little or no benefits in symptoms in the short term, but may result in a higher rate of overall improvement in the short term when worn at night-time only 6.
Treatment Options
- Nonsurgical treatment options for CTS include lifestyle modifications, nighttime splinting, and corticosteroid injections 2.
- Surgical treatment options, such as carpal tunnel release, may be necessary for patients who do not respond to nonsurgical treatment or have advanced symptoms 2.
- Splinting may be used as a conservative treatment option for CTS, but its effectiveness remains unclear 6.
Comparison of Treatment Options
- A comparative study found that splinting plus local corticosteroid injection may be more effective than splinting alone in improving clinical and nerve conduction findings in patients with CTS 3.
- A Cochrane review found that splinting may not provide additional benefits in symptoms or hand function when given together with corticosteroid injection or rehabilitation 6.