Tunnel Vision on Pain: Carpal Tunnel Management

Tingling thumbs, numb fingers, hand tinglies (say THAT out loud!) ... or a hand that just won’t cooperate? Your patients might be wrestling with carpal tunnel syndrome. From splints to surgery, here’s the latest evidence on what actually helps, and what doesn’t.

Carpal tunnel syndrome (CTS) is the most common mononeuropathy, affecting 1–5% of the population, more often in women, and caused by median nerve compression at the wrist.

Symptoms include

• pain

• numbness

• paresthesia in the thumb, index, middle, and radial half of the ring finger,

• Severe cases: thenar muscle weakness and wasting (look for & document this! Indication for urgent referral)

SPLINTING, STEROID, OR SURGERY?

A 2024 Cochrane review found that compared with splinting, surgery probably increases long-term clinical improvement and reduces the need for future surgery, though it offers no clear benefit for symptoms, function, or quality of life.

When compared with corticosteroid injection, surgery showed no meaningful long-term difference in function and only a slight, non–clinically significant reduction in pain.

Evidence for other nonsurgical comparisons was limited and uncertain, and reported surgical harms included painful scars, neuroma, tendon subluxation, infection, and nerve injury. EXAM TIP: Ask about handedness & occupation (especially if referring to a surgeon)

Source