Treatment of carpal tunnel syndrome
- Milind J Kothari, DO
Milind J Kothari, DO
- Professor of Neurology
- Penn State College of Medicine
Carpal tunnel syndrome (CTS) refers to the complex of symptoms and signs brought on by compression of the median nerve as it travels through the carpal tunnel. Patients commonly experience pain, paresthesias, and less commonly, weakness in the median nerve distribution. CTS is the most common compressive focal mononeuropathy seen in clinical practice.
This topic review will discuss treatment of CTS. We will also briefly review the etiology, clinical features, and diagnosis of CTS, which are discussed in greater detail separately. (See "Etiology of carpal tunnel syndrome" and "Carpal tunnel syndrome: Clinical manifestations and diagnosis".)
The carpal tunnel is a defined anatomic space with the following characteristics [1-3]:
●The dorsal surface is formed by the carpal bones, while the volar surface is formed by the transverse carpal ligament (flexor retinaculum), which attaches ulnarly to the hamate and pisiform, and radially to the trapezium and scaphoid tuberosity (figure 1).
●The antebrachial fascia of the forearm is continuous with the transverse carpal ligament of the palm. The four flexor digitorum profundus tendons, four flexor digitorum superficialis tendons, the flexor pollicis longus tendon, and the median nerve pass within the carpal tunnel (figure 2).
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- Natural history
- Global symptom score (GSS)
- Wrist splinting
- - Splinting versus surgery
- Glucocorticoid injection
- - Glucocorticoid injection versus surgery
- Oral glucocorticoids
- Carpal bone mobilization
- Nerve gliding
- Ultrasound therapy
- NSAIDs and other oral medications
- Electrical, magnetic, and laser therapy
- Conservative treatment choices
- - Pregnancy
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS