Management of Carpal Tunnel Syndrome

· General measures

o Avoid repetitive wrist and hand movements

o Improved wrist positioning

· Splint to hold the wrist in dorsiflexion overnight

o This relieves the symptoms and is diagnostic

o If used nightly for several weeks, it may produce full recovery

o Most effective if used within 3 months of the onset of symptoms

· Corticosteroid injection into the carpal tunnel

o Helps in 70% of cases

o Recurrence may occur (80% after 1 year)

o More effective than oral treatments

o Risk of injecting into median nerve

· Nerve conduction studies followed by surgical decompression of carpal tunnel

o Used when symptoms persist or nerve damage is suspected – ie,
thenar atrophy or motor weakness

o Outpatient procedure

o long palmar curvilinear incision to facilitate division of the
transverse carpal ligament and its overlying structures

o Endoscopic carpal tunnel release is a newer procedure that allows
division of the transverse carpal ligament with the overlying structures left
intact

o Wrist splinted for 3 – 4 weeks after surgery

· Diuretics, NSAIDS, oral corticosteroid, pyridoxine (vit B6)

o Varying degrees of success

o Studies show that NSAIDS and diuretics confer no benefit

o Oral corticosteroid shown to work

References

Kumar, P. and Clark, M. (2005) Clinical Medicine 6th Ed, Elsevier Saunders, Philadelphia

Anthony, J. (2003) Management of Carpal Tunnel Syndrome. American Family Physician, 68 (2), 265-272

Available: http://www.aafp.org/afp/20030715/265.pdf