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Carpal tunnel syndrome - Management
Basis for recommendation

  • These recommendations are based on the guideline from the American Academy of Neurology [Quality Standards Subcommittee of the American Academy of Neurology, 1993] and expert opinion in a review article.
  • There is good evidence that local corticosteroid injection provides short-term improvement in symptoms. The risk of median nerve damage from intraneural injection is very small and has been estimated at < 0.1% in competent hands [Bland, 2007]. The major complication is direct injection of corticosteroid into the median nerve leading to severe axonal and myelin degeneration [Haase, 2007]. There is no evidence to support giving more than one injection [Marshall et al, 2007].
  • If compression is severe or there is insufficient improvement with conservative measures then surgery is the only treatment [Kanaan and Sawaya, 2001]. There is good evidence for the effectiveness of surgical treatment by open or endoscopic carpal tunnel release. Most clinicians recommend that if people have not benefited from conservative treatment then they should be considered for surgery.
  • Electrodiagnostic testing is recommended if the diagnosis is in doubt [Quality Standards Subcommittee of the American Academy of Neurology, 1993].
  • Under the government's proposals outlined in The musculoskeletal framework, future referrals may be dealt with increasingly by the local Clinical Assessment and Treatment Service (CATS). The report gives one example where joint working supported one GP practice to undertake carpal tunnel decompression surgery in primary care [DH, 2006].

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