Recommendations

Document Overview

Design and created by Guideline Central in participation with the American Academy of Orthopaedic Surgeons.

Management of Carpal Tunnel Syndrome

American Academy of Orthopaedic Surgeons

Publication Date: May 18, 2024

Page Last Updated: May 5, 2026

Interpreting the Strength of Evidence

Strength of Recommendation
Strength	Overall Strength of Evidence	Description of Evidence Quality
Strong	Strong	Evidence from two or more “High” quality studies with consistent findings for recommending for or against the intervention.
Moderate	Moderate	Evidence from two or more “Moderate” quality studies with consistent findings, or evidence from a single “High” quality study for recommending for or against the intervention.
Limited	Low Strength Evidence or Conflicting Evidence	Evidence from two or more “Low” quality studies with consistent findings or evidence from a single “Moderate” quality study recommending for against the intervention or diagnostic or the evidence is insufficient or conflicting and does not allow a recommendation for or against the intervention.
Consensus*	No Evidence	There is no supporting evidence. In the absence of reliable evidence, the guideline development group is making a recommendation based on their clinical opinion. Consensus statements are published in a separate, complimentary document.

Document Overview

Document Title: Management of Carpal Tunnel Syndrome

Authoring Society: American Academy of Orthopaedic Surgeons

Document Publication Date: May 18, 2024

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.aaos.org/globalassets/quality-and-practice-resources/carpal-tunnel/cts-cpg_4-25-19.pdf

Source Citation: American Academy of Orthopaedic Surgeons. Management of Carpal Tunnel Syndrome Evidence-Based Clinical Practice Guideline. aaos.org/cts2cpg Published 05/18/2024.

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: This clinical practice guideline is based on a systematic review of published studies with regard to the diagnosis and treatment of carpal tunnel syndrome (CTS).

Scope: Assessment and Screening, Counseling, Diagnosis, Prevention, Rehabilitation, Treatment

Diseases/Conditions (MeSH)

D001172 - Arthritis, Rheumatoid

Keywords: CTS, Median Nerve Compression, Wrist/hand pain, carpal Tunnel Syndrome, hand parasthesias, hand weakness, numbness, rheumatoid arthritis

Inclusion Criteria: Male, Female, Adolescent, Adult, Older Adult

Health Care Settings: Ambulatory, Hospital, Operating and Recovery Room, Outpatient, Radiology Services

Intended Users: Nurse, Nurse Practitioner, Occupational Therapist, Physical Therapist, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Supplemental Methodology Resources: Methodology Supplement Technical Review Data Supplement Data Supplement

Number of Source Documents: 285

Literature Search Start Date: Tuesday, March 1, 2022

Literature Search End Date: Tuesday, August 1, 2023

Includes peer/external review process?: Yes

Includes public comment process?: Yes

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Management of Carpal Tunnel Syndrome

Recommendations

DIAGNOSIS: CTS-6, ULTRASONOGRAPHY, NCV/EMG

DIAGNOSIS: MRI, UPPER LIMB NEURODYNAMIC TESTING

CORTICOSTEROID INJECTION

PLATELET-RICH PLASMA (PRP) INJECTION

SURGICAL RELEASE TECHNIQUE

MODES OF ANESTHESIA

POSTOPERATIVE THERAPY

POSTOPERATIVE IMMOBILIZATION

POSTOPERATIVE PAIN: NSAID, ACETAMINOPHEN

RISK FACTORS: KEYBOARDING, CLERICAL WORK

THERAPEUTIC ULTRASOUND

NON-OPERATIVE TREATMENTS VS. PLACEBO/CONTROL

NON-OPERATIVE TREATMENTS: LONG-TERM

COMPARISON OF NON-OPERATIVE TREATMENTS

SITE OF SERVICE

SURGICAL DRAPING

ANTICOAGULATION

PROPHYLACTIC PERIOPERATIVE ANTIBIOTICS

PREOPERATIVE TESTING

ADJUNCTIVE TESTING

POSTOPERATIVE PAIN: TRAMADOL

Interpreting the Strength of Evidence

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology