Summary of Recommendations

Document Overview

Design and created by Guideline Central in participation with the American Physical Therapy Association.

Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome

American Physical Therapy Association

Publication Date: Apr 30, 2019

Page Last Updated: May 5, 2026

American Physical Therapy Association Evidence Grading System

Grade of Evidence
Grade	Recommendation	Description
A	Strong	A preponderance of level I and/or level II studies supports the recommendation, This must include at least 1 level I study.
B	Moderate	A single high-quality randomized controlled trial or a preponderance of level II evidence supports the recommendation.
C	Weak	A single level II study or a preponderance of level II and TV studies supports the recommendation.
D	Conflicting	Higher-quality studies conducted on this topic disagree with respect to their conclusions. The recommendation is based on these conflicting studies.
E	Theoretical/foundational	A preponderance of evidence from animal or cadaver studies, from conceptual models/principles or from basic science/bench research supports this conclusion.
F	Expert opinion	Best practice based on the clinical experience of the guidelines development team.

Document Overview

Document Title: Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome

Authoring Society: American Physical Therapy Association

Document Publication Date: Apr 30, 2019

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.jospt.org/doi/10.2519/jospt.2019.0301

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: Describe evidence-based practice, including diagnosis, prognosis, intervention, and assessments of outcomes for musculoskeletal disorders. Classify and define common musculoskeletal conditions using the World Health Organization's terminology related to impairments of body function and body structure, activity limitations, and participation restrictions. Identify interventions supported by current best evidence to address impairments of body function and structure, activity limitations, and participation restrictions associated with common musculoskeletal conditions. Identify appropriate outcome measures to assess changes resulting from physical therapy interventions in body function and structure as well as in activity and participation of the individual. Provide a description to policy makers, using internationally accepted terminology, of the practice of orthopaedic physical therapists and hand rehabilitation. Provide information for payers and claims reviewers regarding the practice of orthopaedic and hand therapy for common musculoskeletal conditions. Create a reference publication for clinicians, academic instructors, clinical instructors, students, interns, residents, and fellows regarding the best current practice of orthopaedic physical therapy and hand rehabilitation.

Scope: Assessment and Screening, Diagnosis, Management, Rehabilitation, Treatment

Diseases/Conditions (MeSH)

D009408 - Nerve Compression Syndromes

Keywords: Hand pain, carpal Tunnel Syndrome, hand compression, nerve compression

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

Health Care Settings: Ambulatory, Emergency Care, Outpatient

Intended Users: Athletics/Coaching, Nurse, Nurse Practitioner, Occupational Therapist, Physical Therapist, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Number of Source Documents: 409

Literature Search End Date: Thursday, November 1, 2018

Includes peer/external review process?: Yes

Includes public comment process?: No

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?: No

Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome

Summary of Recommendations

DIAGNOSIS

EXAMINATION – OUTCOME MEASURES: ACTIVITY LIMITATIONS/SELF-REPORTED MEASURES

EXAMINATION – ACTIVITY LIMITATIONS/ PHYSICAL PERFORMANCE MEASURES

EXAMINATION – ACTIVITY LIMITATIONS/ PHYSICAL IMPAIRMENT MEASURES

Strength Measures

Sensory and Provocative Measures

INTERVENTIONS – ASSISTIVE TECHNOLOGY

INTERVENTIONS – ORTHOSES

INTERVENTIONS – BIOPHYSICAL AGENTS

INTERVENTIONS – MANUAL THERAPY TECHNIQUES

INTERVENTIONS – THERAPEUTIC EXERCISE

American Physical Therapy Association Evidence Grading System

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology