Medication Summary

Nonsteroidal anti-inflammatory medications (NSAIDs) are frequently prescribed for this condition; caution patients to watch for the usual adverse effects. Short-term diuretic treatment may be helpful in patients with limb swelling. A study by Chang et al in patients with mild-to-moderate CTS found that short-term, low-dose oral steroid treatment (prednisolone, 20 mg qd x 2 wk, then 10 mg qd x 2 wk) was more effective than treatment with a diuretic or an NSAID.^[58]A follow-up study found that 2 weeks of prednisolone provided long-term results comparable to those with 4 weeks of treatment.^[59]

Class Summary

These agents have analgesic and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions. Various NSAIDs may be used.

Naproxen (Anaprox, Naprelan, Naprosyn)

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For relief of mild to moderately severe pain; inhibits inflammatory reactions and pain by decreasing activity of cyclooxygenase, which is responsible for prostaglandin synthesis.

Ibuprofen (Ibuprin, Advil, Motrin)

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DOC for mild to moderately severe pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Ketoprofen (Oruvail, Orudis, Actron)

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For relief of mild to moderately severe pain and inflammation. Small dosages indicated initially in patients with small body size, the elderly, and those with renal or liver disease.

Doses >75 mg do not increase therapeutic effects.

Administer high doses with caution and closely observe patient for response.

Flurbiprofen (Ansaid)

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May inhibit cyclooxygenase, which in turn inhibits prostaglandin biosynthesis. These effects may result in analgesic, antipyretic, and anti-inflammatory activities.

Class Summary

A recent report suggested that short-term oral steroids may be beneficial in CTS.

Prednisolone (AK-Pred, Delta-Cortef, Articulose-50, Econopred)

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Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.

Follow-up

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Media Gallery

Scars from carpal tunnel release surgery.
Anatomy of the carpal tunnel.
Anatomy of the median nerve and the carpal tunnel.

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Author

Friedhelm Sandbrink, MD Assistant Professor of Neurology, Georgetown University School of Medicine; Assistant Clinical Professor of Neurology, George Washington University School of Medicine and Health Sciences; Director, EMG Laboratory and Chief, Chronic Pain Clinic, Department of Neurology, Washington Veterans Affairs Medical Center

Friedhelm Sandbrink, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Neil A Busis, MD Chief of Neurology and Director of Neurodiagnostic Laboratory, UPMC Shadyside; Clinical Professor of Neurology and Director of Community Neurology, Department of Neurology, University of Pittsburgh Physicians

Neil A Busis, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: American Academy of Neurology<br/>Serve(d) as a speaker or a member of a speakers bureau for: American Academy of Neurology<br/>Received income in an amount equal to or greater than $250 from: American Academy of Neurology.

Chief Editor

Nicholas Lorenzo, MD, CPE, MHCM, FAAPL Co-Founder and Former Chief Publishing Officer, eMedicine and eMedicine Health, Founding Editor-in-Chief, eMedicine Neurology; Founder and Former Chairman and CEO, Pearlsreview; Founder and CEO/CMO, PHLT Consultants; Former Chief Medical Officer, MeMD Inc

Nicholas Lorenzo, MD, CPE, MHCM, FAAPL is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Association for Physician Leadership

Disclosure: Nothing to disclose.

Additional Contributors

Stephen A Berman, MD, PhD, MBA Professor of Neurology, University of Central Florida College of Medicine

Stephen A Berman, MD, PhD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, Phi Beta Kappa

Disclosure: Nothing to disclose.