Carpal Tunnel Syndrome: Therapy
This information is provided to you for use in conjunction with your clinical judgment and the specific needs of the patient.
Dwain M. Daniel, D.C.
How this evidence was rated:
Strength of Recommendation Taxonomy (SORT)
March 31, 2009
Carpal tunnel syndrome (CTS) is a common clinical diagnosis associated with significant morbidity. Conservative treatment options, many which demonstrate promising treatment effects, have not been adequately investigated. The following list is comprised of treatments that have been studied at least on a limited basis. If a specific treatment is not on the list, it is because no studies have been performed or located. A significant concern with several of the published articles is “multiple treatment interface”. This occurs when the investigator treats patients with more than one intervention at the same time. An example would be a test group being treated with ultrasound (US) and vitamin B6 at the same time. If improvement is noted one must ask the question “could the B6 alone or ultrasound alone lead to the improvement or was it the combination of B6 and ultrasound?” This research design makes identifying the effective treatment difficult.
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O'Connor D, Marshall S, Massy-Westropp N. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev 2003;(1):CD003219.
[ Medline ID 12535461 ]
Werner RA, Franzblau A, Gell N. Randomized controlled trial of nocturnal splinting for active workers with symptoms of carpal tunnel syndrome. Arch Phys Med Rehabil 2005; 86(1):1-7.
[ MANTIS ID 150085 ]
[ Medline ID 15640980 ]
Walker WC, Metzler M, Cifu DX, Swartz Z. Neutral wrist splinting in carpal tunnel syndrome: a comparison of night-only versus full-time wear instructions. Arch Phys Med Rehabil 2000; 81(4):424-429.
[ MANTIS ID 59956 ]
[ Medline ID 10768530 ]
Piravej K, Boonhong J. Effect of ultrasound thermotherapy in mild to moderate carpal tunnel syndrome. J Med Assoc Thai 2004; 87 Suppl 2:S100-S106.
[ Medline ID 16083171 ]
Oztas O, Turan B, Bora I, Karakaya MK. Ultrasound therapy effect in carpal tunnel syndrome. Arch Phys Med Rehabil 1998; 79(12):1540-1544.
[ MANTIS ID 63770 ]
[ Medline ID 9862296 ]
Bakhtiary AH, Rashidy-Pour A. Ultrasound and laser therapy in the treatment of carpal tunnel syndrome. Aust J Physiother 2004; 50(3):147-151.
[ MANTIS ID 171673 ]
[ Medline ID 15482245 ]
Baysal O, Altay Z, Ozcan C, Ertem K, Yologlu S, Kayhan A. Comparison of three conservative treatment protocols in carpal tunnel syndrome. Int J Clin Pract 2006; 60(7):820-828.
[ Medline ID 16704676 ]
Dincer U, Cakar E, Kiralp MZ, Kilac H, Dursun H. The Effectiveness of Conservative Treatments of Carpal Tunnel Syndrome: Splinting, Ultrasound, and Low-Level Laser Therapies. Photomed Laser Surg 2009 Jan 26.
[ Medline ID 19196106 ]
Akalin E, El O, Peker O, Senocak O, Tamci S, Gulbahar S et al. Treatment of carpal tunnel syndrome with nerve and tendon gliding exercises. Am J Phys Med Rehabil 2002; 81(2):108-113.
[ MANTIS ID 90647 ]
[ Medline ID 11807347 ]
Seradge H, Parker W, Baer C, Mayfield K, Schall L. Conservative treatment of carpal tunnel syndrome: an outcome study of adjunct exercises. J Okla State Med Assoc 2002; 95(1):7-14.
[ Medline ID 11799804 ]
Rozmaryn LM, Dovelle S, Rothman ER, Gorman K, Olvey KM, Bartko JJ. Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome. J Hand Ther 1998; 11(3):171-179.
[ Medline ID 9730093 ]
Muller M, Tsui D, Schnurr R, Biddulph-Deisroth L, Hard J, MacDermid JC. Effectiveness of hand therapy interventions in primary management of carpal tunnel syndrome: a systematic review. J Hand Ther 2004; 17(2):210-228.
[ Medline ID 15162107 ]
Tal-Akabi A, Rushton A. An investigation to compare the effectiveness of carpal bone mobilisation and neurodynamic mobilisation as methods of treatment for carpal tunnel syndrome. Man Ther 2000; 5(4):214-222.
[ MANTIS ID 52573 ]
[ Medline ID 11052900 ]
Gerritsen AA, de Krom MC, Struijs MA, Scholten RJ, de Vet HC, Bouter LM. Conservative treatment options for carpal tunnel syndrome: a systematic review of randomised controlled trials. J Neurol 2002; 249(3):272-280.
[ Medline ID 11993525 ]
Naeser MA. Photobiomodulation of pain in carpal tunnel syndrome: review of seven laser therapy studies. Photomed Laser Surg 2006 Apr;24(2):101-10.
[ Medline ID 16706688 ]
Naeser MA, Hahn KA, Lieberman BE, Branco KF. Carpal tunnel syndrome pain treated with low-level laser and microamperes transcutaneous electric nerve stimulation: A controlled study. Arch Phys Med Rehabil 2002 Jul;83(7):978-88.
[ MANTIS ID 56118 ]
[ Medline ID 12098159 ]
Branco K, Naeser MA. Carpal tunnel syndrome: clinical outcome after low-level laser acupuncture, microamps transcutaneous electrical nerve stimulation, and other alternative therapies--an open protocol study. J Altern Complement Med 1999 Feb;5(1):5-26.
[ MANTIS ID 138746 ]
[ Medline ID 10100028 ]
Davis PT, Hulbert JR, Kassak KM, Meyer JJ. Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trail. J Manipulative Physiol Ther 1998; 21(5):317-326.
[ MANTIS ID 39053 ]
[ Medline ID 96278620 ]
Aufiero E, Stitik TP, Foye PM, Chen B. Pyridoxine hydrochloride treatment of carpal tunnel syndrome: a review. Nutr Rev 2004; 62(3):96-104.
[ Medline ID 15098856 ]
Garfinkel MS, Singhal A, Katz WA, Allan DA, Reshetar R, Schumacher HR, Jr. Yoga-based intervention for carpal tunnel syndrome: a randomized trial. JAMA 1998; 280(18):1601-1603.
[ Medline ID 9820263 ]
Michlovitz S, Hun L, Erasala GN, Hengehold DA, Weingand KW. Continuous low-level heat wrap therapy is effective for treating wrist pain. Arch Phys Med Rehabil 2004; 85(9):1409-1416.
[ MANTIS ID 150187 ]
[ Medline ID 15375809 ]
Burke J, Buchberger DJ, Carey-Loghmani MT, Dougherty PE, Greco DS, Dishman JD. A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. J Manipulative Physiol Ther 2007 Jan;30(1):50-61.
[ MANTIS ID 257214 ]
Brunarski S KBWK. Intermittent axial wrist traction in the conservative treatment for carpal syndrome. J of the Canadian Chiropractic Association 2004; 48(3).
[ MANTIS ID 114503 ]
Porrata H, Porrata A, Sosner J. New carpal ligament traction device for the treatment of carpal tunnel syndrome unresponsive to conservative therapy. J Hand Ther 2007; 20(1):20-27.
[ Medline ID 17254905 ]
Carter R, Aspy CB, Mold J. The effectiveness of magnet therapy for treatment of wrist pain attributed to carpal tunnel syndrome. J Fam Pract 2002; 51(1):38-40.
[ Medline ID 11927062 ]
Gerritsen AA, de Vet HC, Scholten RJ, Bertelsmann FW, de Krom MC, Bouter LM. Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomized controlled trial. JAMA 2002; 288(10):1245-1251.
[ Medline ID 112215131 ]
Kouyoumdjian JA, Morita MP, Molina AF, Zanetta DM, Sato AK, Rocha CE et al. Long-term outcomes of symptomatic electrodiagnosed carpal tunnel syndrome. Arq Neuropsiquiatr 2003; 61(2A):194-198.
[ Medline ID 12806496 ]
Nancollas MP, Peimer CA, Wheeler DR, Sherwin FS. Long-term results of carpal tunnel release. J Hand Surg [Br ] 1995; 20(4):470-474.
[ MANTIS ID 147302 ]
[ Medline ID 7594985 ]
Gerritsen AA, Uitdehaag BM, van Geldere D, Scholten RJ, de Vet HC, Bouter LM. Systematic review of randomized clinical trials of surgical treatment for carpal tunnel syndrome. Br J Surg 2001; 88(10):1285-1295.
[ Medline ID 11578281 ]
Scholten RJ, Gerritsen AA, Uitdehaag BM, van Geldere D, de Vet HC, Bouter LM. Surgical treatment options for carpal tunnel syndrome. Cochrane Database Syst Rev 2004;(4):CD003905.
[ Medline ID 15495070 ]
Prick JJ, Blaauw G, Vredeveld JW, Oosterloo SJ. Results of carpal tunnel release. Eur J Neurol 2003; 10(6):733-736.
[ Medline ID 14641522 ]
Hui AC, Wong S, Leung CH, Tong P, Mok V, Poon D et al. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. Neurology 2005; 64(12):2074-2078.
[ Medline ID 15985575 ]
Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev 2002;(4):CD001554.
[ Medline ID 12519560 ]
Ly-Pen D, Andreu JL, de Blas G, Sanchez-Olaso A, Millan I. Surgical decompression versus local steroid injection in carpal tunnel syndrome: a one-year, prospective, randomized, open, controlled clinical trial. Arthritis Rheum 2005 Feb;52(2):612-9.
[ Medline ID 19692981 ]
Chang MH, Ger LP, Hsieh PF, Huang SY. A randomised clinical trial of oral steroids in the treatment of carpal tunnel syndrome: a long term follow up. J Neurol Neurosurg Psychiatry 2002 Dec;73(6):710-4.
[ Medline ID 12438475 ]
Celiker R, Arslan S, Inanici F. Corticosteroid injection vs. nonsteroidal antiinflammatory drug and splinting in carpal tunnel syndrome. Am J Phys Med Rehabil 2002 Mar;81(3):182-6.
[ MANTIS ID 90633 ]
[ Medline ID 11989514 ]
Nalamachu S, Crockett RS, Mathur D. Lidocaine patch 5 for carpal tunnel syndrome: how it compares with injections: a pilot study. J Fam Pract 2006 Mar;55(3):209-14.
[ Medline ID 16510054 ]
Nalamachu S, Crockett RS, Gammaitoni AR, Gould EM. A comparison of the lidocaine patch 5% vs naproxen 500 mg twice daily for the relief of pain associated with carpal tunnel syndrome: a 6-week, randomized, parallel-group study. MedGenMed 2006;8(3):33.
[ Medline ID 17406167 ]