Carpal Tunnel Syndrome (CTS)

My last entry was querying ‘what treatments are effective for carpal tunnel syndrome’. Here’s what the literature says:

(1) Non-surgical treatment (other than steroid injections)

  • Ergonomic* positioning & equipment – insufficient evidence.  We all know someone (it may even be you) who uses a ‘special’ keyboard and mouse at work to reduce pressure on wrists – unfortunately at present there is insufficient evidence from randomised controlled trials to determine whether ergonomic positioning or equipment is beneficial or harmful for treating carpal tunnel syndrome;

* Ergonomics is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance.

  • Exercise & Mobilisation – limited, low quality evidence.  There is some benefit for yoga and carpal bone mobilisation;
  • Splinting – limited evidence.  A splint worn at night is more effective than no treatment in the short-term;
  • Ultrasound – insufficient, poor quality evidence.  Therapeutic ultrasound may be more effective than placebo for either short- or long-term symptom improvement in people with CTS. There is insufficient evidence to support the benefit of one type of therapeutic ultrasound over another;
  • Acupuncture – insufficient evidence.  The acupuncture studies published to date have poor methodological quality and as such, the existing evidence is not convincing enough to suggest that acupuncture is an effective therapy for CTS;
  • Oral steroids – some evidence.  This needs to be weighed up against the cons of using oral steroids (namely significant side-effects).

In summary, for non-surgical treatment (other than steroid injection):  current evidence shows significant short-term benefit from oral steroids, splinting, ultrasound, yoga and carpal bone mobilisation. Other non-surgical treatments do not produce significant benefit.

(2) Steroid injection – effective.  Local corticosteroid injection for carpal tunnel syndrome provides greater clinical improvement in symptoms one month after injection compared to placebo (a ‘dummy injection containing no steroid’) however significant symptom relief beyond one month has not been demonstrated. Local corticosteroid injection provides significantly greater clinical improvement than oral corticosteroid for up to three months. Local corticosteroid injection is equally as effective as splinting and anti-inflammatory treatment together. Two local corticosteroid injections do not provide significant added clinical benefit compared to one injection.

(3) Surgery – effective.  Surgical treatment of carpal tunnel syndrome relieves symptoms significantly better than splinting. Further research is needed to discover whether this conclusion applies to people with mild symptoms and whether surgical treatment is better than steroid injection

Bottom line, if you:

  • Have CTS: see your doctor (or healthcare provider);
  • ARE NOT pregnant (and have no significant gastric/renal issues), you may want to discuss with your doctor (1) Oral non-steroid anti-inflammatory medication plus night splinting OR (2) Steroid injection;
  • ARE PREGNANT, often no treatment is needed (or is indicated, or indeed safe); once the primary case has been resolved (the oedema accompanying pregnancy), the CTS resolves;
  • Surgery remains an option for those that fail all conservative treatments.

REFERENCES
Page MJ, O’Connor D, Pitt V, Massy-Westropp N. Therapeutic ultrasound for carpal tunnel syndrome. Cochrane Database Syst Rev. 2013 Mar 28;3:CD009601. doi: 10.1002/14651858.CD009601.pub2.
 Page MJ, Massy-Westropp N, O’Connor D, Pitt V. Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev. 2012 Jul 11;7:CD010003. doi: 10.1002/14651858.CD010003.
 Page MJ, O’Connor D, Pitt V, Massy-Westro. Exercise and mobilisation interventions for carpal tunnel syndrome. Cochrane Database Syst Rev. 2012 Jun 13;6:CD009899. doi: 10.1002/14651858.CD009899.
 O’Connor D, Page MJ, Marshall SC, Massy-Westropp N. Ergonomic positioning or equipment for treating carpal tunnel syndrome. Cochrane Database Syst Rev. 2012 Jan 18;1:CD009600. doi: 10.1002/14651858.CD009600.
 Sim H, Shin BC, Lee MS, Jung A, Lee H, Ernst E. Acupuncture for carpal tunnel syndrome: a systematic review of randomized controlled trials. J Pain. 2011 Mar;12(3):307-14. doi: 10.1016/j.jpain.2010.08.006. Epub 2010 Nov 19.
 Verdugo RJ, Salinas RA, Castillo JL, Cea JG. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD001552. doi: 10.1002/14651858.CD001552.pub2.
 Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD001554.
 O’Connor D, Marshall S, Massy-Westropp N. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev. 2003;(1):CD003219.

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