Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-745bb68f8f-b95js Total loading time: 0 Render date: 2025-01-14T20:21:16.676Z Has data issue: false hasContentIssue false

Chapter 18 - Carpal Tunnel Syndrome

from Part V - Extremities

Published online by Cambridge University Press:  01 December 2023

By
Vwaire Orhurhu  and
Kevin Bennett
Edited by
Omar Viswanath  and
Ivan Urits
Omar Viswanath
Affiliation:
Creighton University, Omaha
Ivan Urits
Affiliation:
Southcoast Brain & Spine Center, Wareham
Get access

Summary

Carpal tunnel syndrome (CTS) is the most common cause of peripheral entrapment neuropathy in the United States. It is prevalent in approximately 3% of the American adult population and up to 30% in diabetics with coexisting peripheral neuropathy. Measuring median nerve diameter with ultrasound is a viable alternative to nerve conduction studies when diagnosing CTS. Wrist-splinting, physical therapy, and shock-wave therapy are all possible first-line treatments for mild to moderate CTS. LCI benefits pain and functionality in the short term with only a single injection. Endoscopic decompression surgery is still the gold standard treatment for patients with moderate to severe CTS that is refractory to other treatments.

Keywords

CTSperipheral entrapment neuropathywrist painmedian nervesplinting
Type
Chapter
Information
Cambridge Handbook of Pain Medicine , pp. 131 - 145
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Wang, L. Guiding treatment for carpal tunnel syndrome. Phys Med Rehabil Clin N Am. 2018;29:751–760.CrossRefGoogle ScholarPubMed
Wipperman, J, Goerl, K. Carpal tunnel syndrome: Diagnosis and management. Am Fam Physician. 2016;94(12):993–999.Google ScholarPubMed
Gillig, JD, White, SD, Rachel, JN. Acute carpal tunnel syndrome. A Review of Current Literature Orthop Clin North Am. 2016;47(3):599–607.CrossRefGoogle ScholarPubMed
Weiss, AP, Sachar, K, Gendreau, M. Conservative management of carpal tunnel syndrome: A reexamination of steroid injection and splinting. The Journal of Hand Surgery. 1994;19(3):410–415.CrossRefGoogle ScholarPubMed
Huisstede, BM, van den Brink, J, Randsdorp, MS, Geelen, SJ, Koes, BW. Effectiveness of surgical and postsurgical interventions for carpal tunnel syndrome: A systematic review. Arch Phys Med Rehabil. 2018;99(8):1660–1680.CrossRefGoogle ScholarPubMed
Ingram, J, Mauck, BM, Thompson, NB, Calandruccio, JH. Cost, value, and patient satisfaction in carpal tunnel surgery. Orthop Clin North Am. 2018;49(4):503–507.CrossRefGoogle ScholarPubMed
Padua, L, Coraci, D, Erra, C et al. Carpal tunnel syndrome: Clinical features, diagnosis, and management. Lancet Neurol. 2016;15(12):1273–1284.CrossRefGoogle ScholarPubMed
Wipperman, J, Goerl, K. Carpal tunnel syndrome: Diagnosis and management. Am Fam Physician. 2016;94(12):993–999.Google ScholarPubMed
Sharma, D, Jaggi, AS, Bali, A. Clinical evidence and mechanisms of growth factors in idiopathic and diabetes-induced carpal tunnel syndrome. Eur J Pharmacol. 2018;837:156–163.CrossRefGoogle ScholarPubMed
Minieka, MM, Nishida, T, Benzon, H. Chapter 56 – Entrapment neuropathies. In Honorio T. Benzon, Srinivasa N. Raja, Spencer S. Liu, et al. (eds.). Essentials of Pain Medicine, 3rd ed. Elsevier; 2011. pp. 395–402.CrossRefGoogle Scholar
Festen-Schrier, VJMM, Amadio, PC. The biomechanics of subsynovial connective tissue in health and its role in carpal tunnel syndrome. J Electromyogr Kinesiol. 2018;38:232–239.CrossRefGoogle ScholarPubMed
Papanas, N, Stamatiou, I, Papachristou, S. Carpal tunnel syndrome in diabetes mellitus. Curr Diabetes Rev. 2022;18(4):e010921196025. doi: 10.2174/1573399817666210901114610.CrossRefGoogle ScholarPubMed
Albers, JW, Pop-Busui, R. Diabetic neuropathy: Mechanisms, emerging treatments, and subtypes. Curr Neurol Neurosci Rep. 2014;14(8):473.CrossRefGoogle ScholarPubMed
Shiri, R. Arthritis as a risk factor for carpal tunnel syndrome: A meta-analysis. Scand J Rheumatol. 2016;45(5):339–346.CrossRefGoogle ScholarPubMed
Hammer, HB, Hovden, IA, Haavardsholm, EA, Kvien, TK. Ultrasonography shows increased cross-sectional area of the median nerve in patients with arthritis and carpal tunnel syndrome. Rheumatology. 2006;45:584–588.CrossRefGoogle ScholarPubMed
Karadag, O, Kalyoncu, U, Akdogan, A et al. Sonographic assessment of carpal tunnel syndrome in rheumatoid arthritis: Prevalence and correlation with disease activity. Rheumatol Int. 2012;32:2313–2319.CrossRefGoogle ScholarPubMed
Luckhaupt, SE, Dahlhamer, JM, Ward, BW et al. Prevalence and work-relatedness of carpal tunnel syndrome in the working population, United States, 2010 national health interview survey. Am J Ind Med. 2013;56(6):615–624.CrossRefGoogle ScholarPubMed
Dale, AM, Harris-Adamson, C, Rempel, D, et al. Prevalence and incidence of carpal tunnel syndrome in US working populations: Pooled analysis of six prospective studies. Scand J Work Env Hea. 2013;39(5):495–505.CrossRefGoogle ScholarPubMed
Palmer, KT, Harris, EC, Coggon, D. Carpal tunnel syndrome and its relation to occupation: A systematic literature review. Occup Med (Lond). 2007;57(1):57–66.CrossRefGoogle ScholarPubMed
Franklin, GM, Friedman, AS. Work-related carpal tunnel syndrome: Diagnosis and treatment guideline. Phys Med Rehabil Clin N Am. 2015;26(3):523–537.CrossRefGoogle ScholarPubMed
Sucher, BM, Schreiber, AL. Carpal tunnel syndrome diagnosis. Phys Med Rehabil Clin N Am. 2014;25(2):229–247.CrossRefGoogle ScholarPubMed
Zhang, D, Chruscielski, CM, Blazar, P, Earp, BE. Accuracy of provocative tests for carpal tunnel syndrome. J Hand Surg Glob Online. 2020;2(3):121–125.CrossRefGoogle ScholarPubMed
Sasaki, T, Makino, K, Nimura, A et al. Assessment of grip-motion characteristics in carpal tunnel syndrome patients using a novel finger grip dynamometer system. J Orthop Surg Res. 2020;15(1):245.CrossRefGoogle ScholarPubMed
Sonoo, M, Menkes, DL, Bland, JDP, Burke, D. Nerve conduction studies and EMG in carpal tunnel syndrome: Do they add value? Clin Neurophysiol Pract. 2018;3:78–88.CrossRefGoogle ScholarPubMed
Alanazy, MH. Clinical and electrophysiological evaluation of carpal tunnel syndrome: Approach and pitfalls. Neurosciences (Riyadh). 2017;22(3):169–180.CrossRefGoogle ScholarPubMed
Mills, KR. The basics of electromyography. J Neurol Neurosurg Psychiatry. 2005;76(Suppl 2):ii32–ii35.CrossRefGoogle ScholarPubMed
Duckworth, AD, Jenkins, PJ, McEachan, JE. Diagnosing carpal tunnel syndrome. J Hand Surg Am. 2014;39(7):1403–1407.CrossRefGoogle ScholarPubMed
Fowler, JR, Munsch, M, Tosti, R, Hagberg, WC, Imbriglia, JE. Comparison of ultrasound and electrodiagnostic testing for diagnosis of carpal tunnel syndrome: Study using a validated clinical tool as the reference standard. J Bone Joint Surg Am. 2014;96(17):e148.CrossRefGoogle ScholarPubMed
Page, MJ, Massy-Westropp, N, O’Connor, D, Pitt, V. Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev. 2012;7:CD010003.Google Scholar
Gatheridge, MA, Sholty, EA, Inman, A et al. Splinting in carpal tunnel syndrome: The optimal duration. Mil Med. 2020;185(11–12):e2049–e2054.CrossRefGoogle ScholarPubMed
Krause, D, Roll, SC, Javaherian-Dysinger, H, Daher, N. Comparative efficacy of the dorsal application of Kinesio tape and splinting for carpal tunnel syndrome: A randomized controlled trial. J Hand Ther. 2021;34(3):351–361.CrossRefGoogle ScholarPubMed
Golriz, B, Ahmadi Bani, M, Arazpour, M et al. Comparison of the efficacy of a neutral wrist splint and a wrist splint incorporating a lumbrical unit for the treatment of patients with carpal tunnel syndrome. Prosthet Orthot Int. 2016;40(5):617–623.CrossRefGoogle Scholar
Page, MJ, O’Connor, D, Pitt, V, Massy-Westropp, N. Exercise and mobilisation interventions for carpal tunnel syndrome. Cochrane Database Syst Rev. 2012;(6):CD009899.Google ScholarPubMed
Ijaz, MJ, Karimi, H, Ahmad, A et al. Comparative efficacy of routine physical therapy with and without neuromobilization in the treatment of patients with mild to moderate carpal tunnel syndrome. Biomed Res Int. 2022; 2022:2155765.CrossRefGoogle ScholarPubMed
Wolny, T, Saulicz, E, Linek, P, Shacklock, M, Myśliwiec, A. Efficacy of manual therapy including neurodynamic techniques for the treatment of carpal tunnel syndrome: A randomized controlled trial. J Manipulative Physiol Ther. 2017;40(4):263–272.CrossRefGoogle ScholarPubMed
Shem, K, Wong, J, Dirlikov, B. Effective self-stretching of carpal ligament for the treatment of carpal tunnel syndrome: A double-blinded randomized controlled study. J Hand Ther. 2020;33(3):272–280.CrossRefGoogle ScholarPubMed
Hamzeh, H, Madi, M, Alghwiri, AA, Hawamdeh, Z. The long-term effect of neurodynamics vs exercise therapy on pain and function in people with carpal tunnel syndrome: A randomized parallel-group clinical trial. J Hand Ther. 2021;34(4):521–530.CrossRefGoogle ScholarPubMed
Lewis, KJ, Coppieters, MW, Ross, L et al. Group education, night splinting and home exercises reduce conversion to surgery for carpal tunnel syndrome: A multicentre randomised trial. J Physiother. 2020;66(2):97–104.CrossRefGoogle ScholarPubMed
Horng, YS, Hsieh, SF, Tu, YK et al. The comparative effectiveness of tendon and nerve gliding exercises in patients with carpal tunnel syndrome: A randomized trial. Am J Phys Med Rehabil. 2011;90(6):435–442.CrossRefGoogle ScholarPubMed
Paquette, P, Higgins, J, Danino, MA, Harris, P, Lamontagne, M, Gagnon, DH. Effects of a preoperative neuromobilization program offered to individuals with carpal tunnel syndrome awaiting carpal tunnel decompression surgery: A pilot randomized controlled study. J Hand Ther 2021;34(1):37–46.CrossRefGoogle ScholarPubMed
Huisstede, BM, Hoogvliet, P, Randsdorp, MS et al. Carpal tunnel syndrome: Part I: Effectiveness of nonsurgical treatments – a systematic review. Arch Phys Med Rehabil. 2010;91(7):981–1004.CrossRefGoogle ScholarPubMed
Page, MJ, O’Connor, D, Pitt, V, Massy-Westropp, N. Therapeutic ultrasound for carpal tunnel syndrome. Cochrane Database Syst Rev. 2013;2013(3):CD009601.Google ScholarPubMed
Gesslbauer, C, Mickel, M, Schuhfried, O et al. Effectiveness of focused extracorporeal shock wave therapy in the treatment of carpal tunnel syndrome: A randomized, placebo-controlled pilot study. Wien Klin Wochenschr. 2021;133(11–12):568–577.CrossRefGoogle ScholarPubMed
Wu, YT, Ke, MJ, Chou, YC et al. Effect of radial shock wave therapy for carpal tunnel syndrome: A prospective randomized, double-blind, placebo-controlled trial. J Orthop Res. 2016;34(6):977–984.CrossRefGoogle ScholarPubMed
Paoloni, M, Tavernese, E, Cacchio, A et al. Extracorporeal shock wave therapy and ultrasound therapy improve pain and function in patients with carpal tunnel syndrome: A randomized controlled trial. Eur J Phys Rehabil Med. 2015;51(5):521–528.Google ScholarPubMed
Ke, MJ, Chen, LC, Chou, YC et al. The dose-dependent efficiency of radial shock wave therapy for patients with carpal tunnel syndrome: A prospective, randomized, single-blind, placebo-controlled trial. Sci Rep. 2016;6:38344.CrossRefGoogle ScholarPubMed
Atthakomol, P, Manosroi, W, Phanphaisarn, A et al. Comparison of single-dose radial extracorporeal shock wave and local corticosteroid injection for treatment of carpal tunnel syndrome including mid-term efficacy: A prospective randomized controlled trial. BMC Musculoskelet Disord. 2018;19(1):32.CrossRefGoogle ScholarPubMed
Seok, H, Kim, SH. The effectiveness of extracorporeal shock wave therapy vs. local steroid injection for management of carpal tunnel syndrome: A randomized controlled trial. Am J Phys Med Rehabil. 2013;92(4):327–334.CrossRefGoogle ScholarPubMed
Habibzadeh, A, Mousavi-Khatir, R, Saadat, P, Javadian, Y. The effect of radial shockwave on the median nerve pathway in patients with mild-to-moderate carpal tunnel syndrome: A randomized clinical trial. J Orthop Surg Res. 2022;17(1):46.CrossRefGoogle ScholarPubMed
Marshall, S, Tardif, G, Ashworth, N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev. 2007;(2):CD001554.Google ScholarPubMed
Atroshi, I, Flondell, M, Hofer, M, Ranstam, J. Methylprednisolone injections for the carpal tunnel syndrome: A randomized, placebo-controlled trial. Ann Intern Med. 2013;159(5):309–317.CrossRefGoogle ScholarPubMed
Karadaş, Ö, Tok, F, Akarsu, S, Tekin, L, Balaban, B. Triamcinolone acetonide vs procaine hydrochloride injection in the management of carpal tunnel syndrome: Randomized placebo-controlled study. J Rehabil Med. 2012;44(7):601–604.CrossRefGoogle ScholarPubMed
Peters-Veluthamaningal, C, Winters, JC, Groenier, KH, Meyboom-de Jong, B. Randomised controlled trial of local corticosteroid injections for carpal tunnel syndrome in general practice. BMC Fam Pract. 2010;11:54.CrossRefGoogle ScholarPubMed
So, H, Chung, VCH, Cheng, JCK, Yip, RML. Local steroid injection versus wrist splinting for carpal tunnel syndrome: A randomized clinical trial. Int J Rheum Dis. 2018;21(1):102–107.CrossRefGoogle ScholarPubMed
Evers, S, Bryan, AJ, Sanders, TL et al. Corticosteroid injections for carpal tunnel syndrome: Long-term follow-up in a population-based cohort. Plast Reconstr Surg. 2017;140(2):338–347.CrossRefGoogle Scholar
Guo, XY, Xiong, MX, Zhao, Y et al. Comparison of the clinical effectiveness of ultrasound-guided corticosteroid injection with and without needle release of the transverse carpal ligament in carpal tunnel syndrome. Eur Neurol. 2017;78(1–2):33–40.CrossRefGoogle ScholarPubMed
Racasan, O, Dubert, T. The safest location for steroid injection in the treatment of carpal tunnel syndrome. J Hand Surg Br. 2005;30(4):412–414.CrossRefGoogle ScholarPubMed
Green, DP, MacKay, BJ, Seiler, SJ, Fry, MT. Accuracy of carpal tunnel injection: A prospective evaluation of 756 patients. Hand (N Y), 2020;15(1):54–58.CrossRefGoogle ScholarPubMed
Babaei-Ghazani, A, Roomizadeh, P, Forogh, B et al. Ultrasound-guided versus landmark-guided local corticosteroid injection for carpal tunnel syndrome: A systematic review and meta-analysis of randomized controlled trials. Arch Phys Med Rehabil. 2018;99(4):766–775.CrossRefGoogle ScholarPubMed
Lee, JY, Park, Y, Park, KD, Lee, JK, Lim, OK. Effectiveness of ultrasound-guided carpal tunnel injection using in-plane ulnar approach: A prospective, randomized, single-blinded study. Medicine (Baltimore). 2014;93(29):e350.CrossRefGoogle ScholarPubMed
Malahias, MA, Chytas, D, Mavrogenis, AF et al. Platelet-rich plasma injections for carpal tunnel syndrome: A systematic and comprehensive review. Eur J Orthop Surg Traumatol. 2019;29(1):1–8.CrossRefGoogle ScholarPubMed
Catapano, M, Catapano, J, Borschel, G et al. Effectiveness of platelet-rich plasma injections for nonsurgical management of carpal tunnel syndrome: A systematic review and meta-analysis of randomized controlled trials. Arch Phys Med Rehabil. 2020;101(5):897–906.CrossRefGoogle ScholarPubMed
Rankin, IA, Sargeant, H, Rehman, H, Gurusamy, KS. Low‐level laser therapy for carpal tunnel syndrome. Cochrane Database Syst. Rev. 2017;8(8):CD012765.Google ScholarPubMed
Scholten, RJPM, Mink van der Molen, A, Uitdehaag, BMJ, Bouter, LM, de Vet, HCW. Surgical treatment options for carpal tunnel syndrome. Cochrane Database Syst. Rev. 2007;(4):CD003905. doi: 10.1002/14651858.CD003905.pub3.Google ScholarPubMed
Verdugo, RJ, Salinas, RA, Castillo, JL, Cea, G. Surgical versus non‐surgical treatment for carpal tunnel syndrome. Cochrane Database Syst. Rev. 2008;(4):CD001552. doi: 10.1002/14651858.CD001552.pub2.Google ScholarPubMed
Vasiliadis, HS, Georgoulas, P, Shrier, I, Salanti, G, Scholten, RJ. Endoscopic release for carpal tunnel syndrome. Cochrane Database Syst Rev. 2014;(1):CD008265.Google ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×