Management of Carpal Tunnel Syndrome

Publication Date: May 18, 2024
Last Updated: May 23, 2024

Recommendations

DIAGNOSIS: CTS-6, ULTRASONOGRAPHY, NCV/EMG

Strong evidence suggests that CTS-6 can be used to diagnose carpal tunnel syndrome, in lieu of routine use of Ultrasonography, or NCV/EMG. (S)
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DIAGNOSIS: MRI, UPPER LIMB NEURODYNAMIC TESTING

Moderate evidence suggests that MRI and Upper Limb Neurodynamic Testing should not be used to diagnose carpal tunnel syndrome. (M)
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CORTICOSTEROID INJECTION

Strong evidence suggests corticosteroid injection does not provide long-term improvement of carpal tunnel syndrome.
(S)
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PLATELET-RICH PLASMA (PRP) INJECTION

Strong evidence suggests PRP Injection does not provide long-term benefits in non-operative treatment of carpal tunnel syndrome (leukocyte rich or leukocyte poor PRP). (S)
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SURGICAL RELEASE TECHNIQUE

Strong evidence suggests that there is no difference in patient reported outcomes between a mini-open carpal tunnel release and an endoscopic carpal tunnel release. (S)
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MODES OF ANESTHESIA

Strong evidence suggests local anesthesia alone can be used for carpal tunnel release. (S)
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POSTOPERATIVE THERAPY

Moderate evidence suggests postoperative supervised therapy should not be routinely prescribed after carpal tunnel release. (M)
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POSTOPERATIVE IMMOBILIZATION

Moderate evidence suggests immobilization through sling or orthosis (e.g., splint, brace) should not be used after carpal tunnel release. (M)
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POSTOPERATIVE PAIN: NSAID, ACETAMINOPHEN

Strong evidence suggests that NSAIDs and/or acetaminophen should be used after carpal tunnel release for postoperative pain management. (S)
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RISK FACTORS: KEYBOARDING, CLERICAL WORK

In the absence of reliable evidence, it is the opinion of the workgroup that there is no association between high keyboard use and carpal tunnel syndrome. (C)
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THERAPEUTIC ULTRASOUND

Evidence suggests therapeutic ultrasound does not provide long-term improvement of carpal tunnel syndrome. (L)
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NON-OPERATIVE TREATMENTS VS. PLACEBO/CONTROL

Evidence suggests that the following non-operative treatments do not demonstrate superiority over control or placebo: acupressure, insulin injection, heat therapy, magnet therapy, nutritional supplementation, oral diuretic, oral NSAID, oral anticonvulsant, phonophoresis. (L)
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NON-OPERATIVE TREATMENTS: LONG-TERM

Evidence suggests the following non-operative treatments do not improve long-term patient reported outcomes for carpal tunnel syndrome: oral corticosteroid, hyaluronic acid injection, hydro dissection, kinesiotaping, laser therapy, peloid therapy, perineural injection therapy, topical treatment, shockwave therapy, exercise, ozone injection, massage therapy, manual therapy, pulsed radiofrequency. (L)
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COMPARISON OF NON-OPERATIVE TREATMENTS

Evidence suggests no significant difference in patient reported outcomes between non operative treatment techniques for carpal tunnel syndrome. (L)
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SITE OF SERVICE

Limited evidence suggests carpal tunnel release may be safely conducted in the office setting. (L)
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SURGICAL DRAPING

In the absence of reliable evidence, it is the opinion of the workgroup that limited draping is an option for carpal tunnel release. (C)
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ANTICOAGULATION
 

Limited evidence suggests anticoagulation medication may be safely continued for carpal tunnel release. (L)
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PROPHYLACTIC PERIOPERATIVE ANTIBIOTICS

Limited evidence suggests perioperative prophylactic antibiotics are not indicated for the prevention of surgical site infection following carpal tunnel release. (L)
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PREOPERATIVE TESTING

In the absence of sufficient evidence specific to carpal tunnel, it is the opinion of the workgroup that routine pre-operative testing (e.g., labs, CXR, EKG) is not indicated. (C)
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ADJUNCTIVE TESTING

In the absence of reliable evidence, it is the opinion of the workgroup that, when multiple risk factors for amyloidosis are present, pathological analysis of tenosynovium may be performed. (C)
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POSTOPERATIVE PAIN: TRAMADOL

In the absence of reliable evidence, it is the opinion of the workgroup that Tramadol may be considered over other opioids for postoperative pain management. (C)
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Recommendation Grading

Overview

Title

Management of Carpal Tunnel Syndrome

Authoring Organization

Publication Month/Year

May 18, 2024

Last Updated Month/Year

May 29, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

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).

Inclusion Criteria

Male, Female, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient, Radiology services, Operating and recovery room

Intended Users

Nurse, nurse practitioner, occupational therapist, physical therapist, physician, physician assistant

Scope

Counseling, Diagnosis, Assessment and screening, Treatment, Prevention, Rehabilitation

Diseases/Conditions (MeSH)

D001172 - Arthritis, Rheumatoid

Keywords

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

Source Citation

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

Methodology

Number of Source Documents
285
Literature Search Start Date
March 1, 2022
Literature Search End Date
August 1, 2023