Management of carpal tunnel syndrome

Carpal tunnel syndrome affects approximately 3 percent of adults in the United States. Pain and paresthesias in the distribution of the median nerve are the classic symptoms. While Tinel's sign and a positive Phalen's maneuver are classic clinical signs of the syndrome, hypalgesia and weak thumb abduction are more predictive of abnormal nerve conduction studies. Conservative treatment options include splinting the wrist in a neutral position and ultrasound therapy. Orally administered corticosteroids can be effective for short-term management (two to four weeks), but local corticosteroid injections may improve symptoms for a longer period. A recent systematic review demonstrated that nonsteroidal anti-inflammatory drugs, pyridoxine, and diuretics are no more effective than placebo in relieving the symptoms of carpal tunnel syndrome. If symptoms are refractory to conservative measures or if nerve conduction studies show severe entrapment, open or endoscopic carpal tunnel release may be necessary. Carpal tunnel syndrome should be treated conservatively in pregnant women because spontaneous postpartum resolution is common.