Clinical Evidence Handbook

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Carpal Tunnel Syndrome

 


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Am Fam Physician. 2016 Nov 15;94(10):830-831.

Author disclosure: Nigel L. Ashworth is coauthor of a systematic review referenced in this review.

Carpal tunnel syndrome (CTS) is a collection of clinical symptoms and signs caused by compression of the median nerve within the carpal tunnel.

  • Classic symptoms include numbness, tingling, burning, or pain in at least two of the three digits supplied by the median nerve (i.e., the thumb and the index and middle fingers).

  • Symptoms can resolve within six months in about one-third of persons, particularly younger persons, whereas poor prognosis is often indicated by bilateral symptoms and a positive Phalen test. However, the severity of symptoms and signs does not often correlate well with the extent of nerve compression.

Local corticosteroid injections seem beneficial in treating CTS compared with placebo.

  • Risks associated with local corticosteroid injections into the carpal tunnel include tendon rupture and injection into the median nerve.

We do not know whether diuretics or non-steroidal anti-inflammatory drugs are effective in treating CTS because the randomized controlled trials identified have been too small to draw reliable conclusions.

We do not know whether therapeutic ultrasound or wrist splints are effective in relieving symptoms of CTS.

We found insufficient randomized controlled trial evidence to assess whether surgery is more effective than no treatment. However, there is consensus that surgery is more effective than no treatment, but a trial of surgery vs. sham surgery would be unethical.

  • Surgery may improve clinical outcomes compared with wrist splints.

  • We do not know whether surgery is as effective as local corticosteroid injections in treating CTS.

  • Both endoscopic and open carpal tunnel release seem to improve symptoms, although the data are unclear as to which is more beneficial. Both may be associated with several adverse effects.

View/Print Table

Clinical Questions

What are the effects of drug treatments for carpal tunnel syndrome?

Likely to be beneficial

Corticosteroids (local injection)

Unknown effectiveness

Diuretics

Nonsteroidal anti-inflammatory drugs

What are the effects of nondrug treatments for carpal tunnel syndrome?

Unknown effectiveness

Therapeutic ultrasound

Wrist splints

What are the effects of surgical treatments for carpal tunnel syndrome?

Likely to be beneficial

Surgery (vs. no treatment or placebo)*

Trade-off between benefits and harms

Endoscopic carpal tunnel release vs. open carpal tunnel release (seem equally effective at improving symptoms but both associated with adverse effects)

Surgery vs. local corticosteroid injection (unclear which is most effective; both associated with adverse effects)

Surgery vs. wrist splint (surgery more effective but associated with adverse effects)


*—There is consensus that surgery is effective in persons who have not responded to nonsurgical treatment.

Clinical Questions

What are the effects of drug treatments for carpal tunnel syndrome?

Likely to be beneficial

Corticosteroids (local injection)

Unknown effectiveness

Diuretics

Nonsteroidal anti-inflammatory drugs

What are the effects of nondrug treatments for carpal tunnel syndrome?

Unknown effectiveness

Therapeutic ultrasound

Wrist splints

What are the effects of surgical treatments for carpal tunnel syndrome?

Likely to be beneficial

Surgery (vs. no treatment or placebo)*

Trade-off between benefits and harms

Endoscopic carpal tunnel release vs. open carpal tunnel

Author disclosure: Nigel L. Ashworth is coauthor of a systematic review referenced in this review.

This is one in a series of chapters excerpted from the Clinical Evidence Handbook, published by the BMJ Publishing Group, London, U.K. The medical information contained herein is the most accurate available at the date of publication. More updated and comprehensive information on this topic may be available in future print editions of the Clinical Evidence Handbook, as well as online at http://www.clinicalevidence.bmj.com (subscription required).

This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.

A collection of Clinical Evidence Handbook published in AFP is available at http://www.aafp.org/afp/bmj.



 

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