Other Treatments Supported by Research for Carpal Tunnel Syndrome

Nerve-gliding exercises have been recommended for the treatment of CTS. According to the research, nerve-gliding exercises are no better than a night splint in relieving CTS symtoms. (1)

Therapeutic ultrasound has also been studied as a treatment option for CTS. Due to the low quality of the research, it is difficult to determine if ultrasound is more effective than no treatment at all. (1)

Systemic corticosteroids are often prescribed by physicians in the treatment of inflammatory conditions. In this case, they are prescribed to treat the inflammation of the carpal tunnel, especially the median nerve and tendons of the flexor digitorum superficialis and profundus. Moderate-quality evidence in the form of a systematic review has shown that orally administered systemic corticosteroids are more effective than a placebo. The review found that oral corticosteroids (prednisolone or prednisone for 10 days–4 weeks) significantly improved CTS symptoms compared with a placebo at 4 and 8 weeks. (7) However, there are some possible adverse effects of taking oral corticosteroids. Systemic corticosteroids commonly cause nausea, anxiety, acne, menstrual irregularities, insomnia, headaches, and mood swings. They can also cause peptic ulcer, corticosteroid psychosis, osteoporosis, and adrenal insufficiency. (1)

If more conservative measures do not provide relief, there are other more invasive treatments.
Local injection of corticosteroids has been documented as an effective treatment for CTS. (8,9) According to these studies, local injection corticosteroid injections reduced patients symptoms (pain, paraesthesia, motor weakness) at 2 weeks, 1 month and 6 weeks. (8,9) In studies that compared local injections to systemic administration of corticosteroids, local injections seem to provide more relief of symptoms.  However, known risks associated with local corticosteroid injection into the carpal tunnel include tendon rupture and injection into the median nerve. (9)  Studies that assessed the efficacy of Non-steroidal anti-inflammatories (NSAIDS) and diuretics concluded that they are no better than a placebo in the treatment of CTS. (9)

Surgical intervention has been used on patients who do not respond to conservative treatment of CTS.  According to the research, surgery seems to improve clinical outcomes (decrease pain and paraethesia, improve hand function, decrease time off from work) compared with wrist splints. Since both treatments positively affect CTS symptoms, it is difficult to determine whether surgery is as effective as local corticosteroid injections. Both endoscopic surgery and open carpal tunnel release seem to improve symptoms, although the data are unclear as to which is more beneficial. Both are associated with several adverse effects, including nerve injuries, hemorrhage, infection, persistent pain (in wrist or over scar), and persistence/recurrence of symptoms of CTS. (10)

Carpal Tunnel Open Surgery

Summary of Research-Based Massage for Carpal Tunnel Syndrome

Based on the research, no treatment is a panacea for CTS.  Common sense tells us to rest the wrist and refrain from activities that exacerbate symptoms.  Ice and topical anti-inflammatories may provide a counter-irritant effect, but there are some treatments that have been shown to be effective, including wearing night-splints, carpal-tunnel specific massage, systemic or locally injected corticosteroids, and as a last resort, surgical intervention.  The author of this article has suffered with CTS in the past and was able to recover using rest, ergonomic adjustments, ice, topical anti-inflammatories (arnica oil), splinting and massage.  Refer to the supplemental video for anatomy and massage technique demonstrations.

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