Orthopedic Surgery for Carpal Tunnel Syndrome Guidelines

Updated: Apr 06, 2022
  • Author: David A Fuller, MD; Chief Editor: Harris Gellman, MD  more...
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Guidelines Summary

In February 2016, the American Academy of Orthopaedic Surgeons (AAOS) published an evidence-based clinical practice guideline for the management of carpal tunnel syndrome (CTS), which included the following recommendations [6] :

  • The routine use of magnetic resonance imaging (MRI) for CTS diagnosis is not recommended
  • Thenar atrophy, or diminished thumb muscle mass, is associated with CTS; however, a lack of thenar atrophy is not enough to rule out CTS
  • Do not use single results from common tests and maneuvers (muscle testing, nerve stress tests, etc.), and/or medical history and demographic information (sex/gender, ethnicity, co-morbidities, BMI, age, etc.) independently to affirm CTS diagnosis
  • Exercise and physical activity are associated with a decreased risk for developing CTS
  • Factors that may put patients at risk for CTS include obesity and, to a lesser extent, perimenopausal status, wrist ratio/index, rheumatoid arthritis, psychosocial factors, gardening, distal upper extremity tendinopathies, hand activity, assembly line work, computer work, vibration, tendonitis, and workplace forceful grip/exertion
  • The guidelines recommend splinting, steroids (oral or injection), the use of ketoprofen phonophoresis gel, and/or magnetic therapy; there is limited evidence to support therapeutic ultrasound or laser therapy for CTS symptoms
  • Surgery is recommended, when necessary, to release the transverse carpal ligament—the strong band of connective tissue that covers the top of the carpal wrist structure—to relieve symptoms and improve hand function
  • Surgical treatment of carpal tunnel syndrome should have a greater treatment benefit at 6 and 12 months as compared with splinting, nonsteroidal anti-inflammatory drugs (NSAIDs)/therapy, and a single steroid injection