Carpal Tunnel Syndrome

Medical Treatment of Carpal Tunnel.
Carpal tunnel syndrome (CTS) is the most frequent local peripheral neuropathy. This disease affects 3% of the adult population in USA is more common after age 30and appearing more in women than men by a ratio of 3:1 (1,2,3).There are several alternatives in the treatment of CTS including (1-2):
1. - General: avoid repetitive movements and use of restraint2. - Pharmacological measures: NSAIDs, vitamin B6, steroids and diuretics
3. - Local injection of corticosteroids.
4. - Surgery considered when patients do not respond to conservative measures, whenthere is severe impairment in electromyography (EMG) and when there is presence of thenar atrophy or motor weakness.
Alternative Medical Treatment
A review in 2004 by Dra. Lorena Valenzuela DeBlasis. Family Medicine Resident PUC evaluated the various non-surgical treatment options, including two systematic reviews and 16 randomized controlled trials (CKD) (1-3). The findings of this reviewin relation to the interventions studied are:
Immobilization: A systematic review concluded that all studies have serious methodological flaws, so we can not conclude the effectiveness of thistherapy.
Local injection of corticosteroids: A systematic review and 4 CKD found symptomatic relief treatment month.
Use of oral corticosteroids: 2 ERC found symptomatic relief with steroid use in theshort term. 1 ERC showed that the use of oral corticosteroids for 10 days is less effective than local injection of corticosteroids.
Using ultrasound: There is controversial evidence: 1 ERC found mildto moderate improvement, however another ERC found no difference with placebo.
NSAIDs, diuretics and vitamin B6: The evidence to date has shown no improvement relative to placebo
In most studiesemphasizes a high response rate to placebo treatment: about 50%.
According: Felicity Goodyear-Smith, Bruce Arroll. What Can Family Physicians Offer Patients With Carpal Tunnel Syndrome Other Than...