Management for carpal tunnel syndrome

Currie, 2022Calandruccio, 2018

Management for carpal tunnel syndrome includes treatment of any contributing medical condition (if present). Treatment choice for symptomatic relief depends on patient factors, including individual preference, and whether the patient is pregnant or breastfeeding. Initial management is nonsurgical.

Splinting and hand braces may provide short-term symptomatic relief for people with carpal tunnel syndromeCurrie, 2022Ostergaard, 2020. Wrist splints and soft wrist braces have been shown to be effective for relief of symptoms and improvement in function when compared with no treatment. Elevating the forearm on a pillow at night can also give symptomatic relief.

Local corticosteroid injection near the carpal tunnel may provide symptomatic relief, especially if inflammatory arthritis is also present. If available, local corticosteroid injection is the first-line treatment and can be repeated if symptoms recur. Up to 80% of people may have symptom relief for up to 6 weeks after injectionCalandruccio, 2018. A clinician experienced in giving soft-tissue injections is usually required, because the carpal tunnel is a very small space. Alternatively, injection can be performed under radiological guidance (eg ultrasound-guidance)Wang, 2017.

Local corticosteroid injection can be used in people who are pregnant or breastfeeding and is preferred over the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for analgesia. For principles of use and example doses of local corticosteroid injections, see Principles of using local corticosteroid injections for musculoskeletal pain.

A trial of simple analgesia (such as paracetamol or NSAID) is reasonable initially, although there is no evidence of clear benefitOstergaard, 2020; see Analgesia for acute soft-tissue limb conditions. NSAIDs should be avoided in pregnancy and must be avoided after 30 weeks’ gestation. For advice on the use of NSAIDs in people who are pregnant or breastfeeding, see Potential harms of NSAID use during pregnancy and NSAID use in people who are breastfeeding.

Note: In general, NSAIDs should be avoided in pregnancy and must be avoided after 30 weeks’ gestation.

Patients should be referred (if necessary) to a hand surgeon for an opinion on surgery to release the carpal tunnel if they:

  • do not respond to nonsurgical treatment
  • have progressive sensory or motor deficits
  • have moderate to severe abnormality on nerve conduction studies.

Surgery should be avoided in people who are pregnant (if possible) because symptoms almost always resolve following delivery.