Tunel carpiano

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Int J Clin Rheumtol. Author manuscript; available in PMC 2010 December 1.
Published in final edited form as: Int J Clin Rheumtol. 2010 February ; 5(1): 129–142. doi:10.2217/IJR.09.63.

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Current options for nonsurgical management of carpal tunnel syndrome
Hans Carlson†, AgathaColbert, Jennifer Frydl, Elizabeth Arnall, Molly Elliot, and Nels Carlson

Abstract
Carpal tunnel syndrome (CTS) is the most common of the entrapment neuropathies. Surgical decompression is commonly performed and has traditionally been considered the defnitive treatment for CTS. Conservative treatment options include physical therapy, bracing, steroid injections and alternative medicine. While CTSis often progressive, patients may get better without formal treatment. The resolution of symptoms is not necessarily related to the severity of the clinical findings and self-limited activity is common. The current literature suggests that bracing and corticosteroid injections may be useful in the nonsurgical treatment of CTS, although the benefits may be short term. There is limited evidenceregarding the efficacy of other treatments, such as therapy, exercise, yoga, acupuncture, lasers and magnets, and further studies are needed. Surgery is recommended for progressive functional deficits and significant pain.

Keywords alternative therapy; braces; carpal tunnel syndrome; conservative treatment; corticosteroid injection; exercise; treatment outcome

Overview
Carpal tunnel syndrome(CTS) is the most common of the entrapment neuropathies [1]. While the published incidence and prevalence of CTS is variable and complicated by the method of diagnosis, various investigations have produced estimates of population incidence ranging from 0.125 to 1% [2]. Carpal tunnel syndrome represents the compression of the median nerve within the carpal tunnel. The borders of the carpal tunnelare wrist carpal bones on the medial, lateral and dorsal aspect and the transverse carpal ligament on the volar aspect. The median nerve and nine of the finger and thumb flexor tendons pass through this space. CTS is characterized by symptoms of numbness, tingling and paraethesias, which are not always limited to the median nerve distribution. Individuals with CTS tend to initially present withintermittent symptoms that may be worse at night or with repetitive upper-extremity activity. The symptoms may improve with splinting, repositioning or vigorous shaking of the hand [3–6].

†

Author for correspondence: Oregon Health & Science University, Department of Orthopaedics & Rehabilitaton, Mail Code: OP-31, 3181 S.W., Sam Jackson Park Road, Portland, Oregon 97239-3098, USA, Tel.: +1 503494 6406, Fax: +1 503 494 5050, carlsonh@ohsu.edu. Financial & competing interests disclosure The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, experttestimony, grants or patents received or pending, or royalties. No writing assistance was utilized in the production of this manuscript.

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Physical examination findings in more involved cases may present with neurologic deficits, including impaired sensation, two-point discrimination in the median nerve distribution or thenar weakness. Milder cases may only present withpositive carpal tunnel provocative maneuvers (e.g., with Phalen’s test and Tinel’s sign) with normal neurologic examination findings. Nerve conduction studies (NCS) are frequently performed for confirming the diagnosis of CTS. Conservative treatment may include physical therapy, bracing, steroid injections and alternative therapies. However, surgical decompression (carpal tunnel release) is often...