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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].
  • If carpal tunnel syndrome arises from inflammatory arthritis (e.g. rheumatoid arthritis) then treatment of the underlying condition generally relieves the carpal tunnel symptoms [Katz and Simmons, 2002].
  • The purpose of treatment is to alleviate symptoms and, in some people, to prevent worsening of the condition. As carpal tunnel syndrome is not necessarily progressive there is nothing to be gained by treating people (mostly elderly) who have thenar wasting but no symptoms [Bland, 2007].
  • Evidence from observational studies shows that symptoms resolve spontaneously in some people: good prognostic indicators include short duration of symptoms, a young age, and carpal tunnel syndrome due to pregnancy.
  • Activity modification has no positive support from any randomized trials [Bland, 2007]. The benefit of modifying the person's activities remains uncertain [Katz and Simmons, 2002]. However the American Academy of neurology suggests modification of activities [Quality Standards Subcommittee of the American Academy of Neurology, 1993] and expert opinion in a review article suggested that it is reasonable to advise that people minimize any activities that exacerbate their symptoms [Katz and Simmons, 2002]. There is limited evidence that carpal tunnel mobilization and the use of workplace interventions (ergonomic adjustments) help people with carpal tunnel syndrome [Verhagen et al, 2006].
  • Treatment focuses on decompression of the median nerve in the canal.
    • There is good evidence that wrist splinting is effective in the short term in about 50% of people. In the long term, surgical treatment relieves symptoms of carpal tunnel syndrome more effectively than splinting. The neutral position of the splint decreases the potential for nerve stretching and therefore alleviates symptoms [Kanaan and Sawaya, 2001; Bland, 2007].
    • Although there is moderate evidence for the effectiveness of oral corticosteroids, adverse effects preclude their use [Bland, 2007].
    • There is limited or no evidence for short-term benefit from other non surgical treatments (e.g. ultrasound, yoga, vitamin B6).
    • There is no evidence to recommend the use of diuretics or nonsteroidal anti-inflammatory drugs.

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