Treatment of carpal tunnel syndrome

Michael Warren Keith, Victoria Masear, Peter C. Amadio, Michael Andary, Richard W. Barth, Brent Graham, Kevin Chung, Kent Maupin, William C. Watters, Robert H. Haralson, Charles M. Turkelson, Janet L. Wies, Richard McGowan

Research output: Contribution to journalReview article

80 Scopus citations

Abstract

In September 2008, the Board of Directors of the American Academy of Orthopaedic Surgeons approved a clinical practice guideline on the treatment of carpal tunnel syndrome. This guideline was subsequently endorsed by the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. The guideline makes nine specific recommendations: A course of nonsurgical treatment is an option in patients diagnosed with carpal tunnel syndrome. Early surgery is an option with clinical evidence of median nerve denervation or when the patient so elects. Another nonsurgical treatment or surgery is suggested when the current treatment fails to resolve symptoms within 2 to 7 weeks. Sufficient evidence is not available to provide specific treatment recommendations for carpal tunnel syndrome associated with such conditions as diabetes mellitus and coexistent cervical radiculopathy. Local steroid injection or splinting is suggested before considering surgery. Oral steroids or ultrasound are options. Carpal tunnel release is recommended as treatment. Heat therapy is not among the options to be used. Surgical treatment of carpal tunnel syndrome by complete division of the flexor retinaculum is recommended. Routine use of skin nerve preservation and epineurotomy is not suggested when carpal tunnel release is performed. Prescribing preoperative antibiotics for carpal tunnel surgery is an option. It is suggested that the wrist not be immobilized postoperatively after routine carpal tunnel surgery. It is suggested that instruments such as the Boston Carpal Tunnel Questionnaire and the Disabilities of the Arm, Shoulder, and Hand questionnaire be used to assess patient responses to carpal tunnel syndrome treatment for research.

Original languageEnglish (US)
Pages (from-to)397-405
Number of pages9
JournalJournal of the American Academy of Orthopaedic Surgeons
Volume17
Issue number6
DOIs
StatePublished - Jun 2009

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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    Keith, M. W., Masear, V., Amadio, P. C., Andary, M., Barth, R. W., Graham, B., Chung, K., Maupin, K., Watters, W. C., Haralson, R. H., Turkelson, C. M., Wies, J. L., & McGowan, R. (2009). Treatment of carpal tunnel syndrome. Journal of the American Academy of Orthopaedic Surgeons, 17(6), 397-405. https://doi.org/10.5435/00124635-200906000-00008