Evidence-based medicine| Volume 34, ISSUE 3, P531-534, March 2009

Download started.


Nonsurgical Treatment of Carpal Tunnel Syndrome

  • Brent Graham
    Corresponding author: Brent Graham, MD, Toronto Western Hospital, 399 Bathurst Street, East Wing 2-425, Toronto, Ontario M5T 2S8, Canada
    University of Toronto, University Health Network Hand Program, Toronto Western Hospital, Toronto, Ontario, Canada
    Search for articles by this author
      A 45-year-old woman presents with a complaint of intermittent numbness and tingling in the right hand that started spontaneously about 6 months previously and bothers her more at night than during the day. The numbness wakes her from sleep nearly every night. The sensory disturbance involves the index, middle, and ring fingers and is most pronounced in the middle finger. There is no atrophy of the intrinsic musculature, including the thenar eminence, and she has strong palmar abduction of the thumb. Two-point discrimination is normal. There is a positive Tinel sign to percussion over the median nerve at the carpal tunnel. The Phalen test is positive. Her family physician has already obtained electrodiagnostic tests, which show that median nerve sensory conduction velocity is decreased across the carpal tunnel. At this point, the patient has not received any treatment for these symptoms.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Gerritsen A.A.
        • de Vet H.C.
        • Scholten R.J.
        • Bertelsmann F.W.
        • de Krom M.C.
        • Bouter L.M.
        Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomized controlled trial.
        JAMA. 2002; 288: 1245-1251
        • Garland H.
        • Langworth E.P.
        • Taverner D.
        • Clark J.M.
        Surgical treatment for the carpal tunnel syndrome.
        Lancet. 1964; 1: 1129-1130
        • Hui A.C.
        • Wong S.
        • Leung C.H.
        • Tong P.
        • Mok V.
        • Poon D.
        • et al.
        A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome.
        Neurology. 2005; 64: 2074-2078
        • Demirci S.
        • Kutluhan S.
        • Koyuncuoglu H.R.
        • Kerman M.
        • Heybeli N.
        • Akkus S.
        • et al.
        Comparison of open carpal tunnel release and local'steroid treatment outcomes in idiopathic carpal tunnel syndrome.
        Rheumatol Int. 2002; 22: 33-37
        • Manente G.
        • Torrieri F.
        • Di Blasio F.
        • Staniscia T.
        • Romano F.
        • Uncini A.
        An innovative hand brace for carpal tunnel syndrome: a randomized controlled trial.
        Muscle Nerve. 2001; 24: 1020-1025
        • Premoselli S.
        • Sioli P.
        • Grossi A.
        • Cerri C.
        Neutral wrist splinting in carpal tunnel syndrome: a 3- and 6-months clinical and neurophysiologic follow-up evaluation of night-only splint therapy.
        Eura Medicophys. 2006; 42: 121-126
        • Walker W.C.
        • Metzler M.
        • Cifu D.X.
        • Swartz Z.
        Neutral wrist splinting in carpal tunnel syndrome: a comparison of night-only versus full-time wear instructions.
        Arch Phys Med Rehabil. 2000; 81: 424-429
        • Akalin E.
        • El O.
        • Peker O.
        • Senocak O.
        • Tamci S.
        • Gülbahar S.
        • et al.
        Treatment of carpal tunnel syndrome with nerve and tendon gliding exercises.
        Am J Phys Med Rehabil. 2002; 81: 108-113
        • Ebenbichler G.R.
        • Resch K.L.
        • Nicolakis P.
        • Wiesinger G.F.
        • Uhl F.
        • Ghanem A.H.
        • et al.
        Ultrasound treatment for treating the carpal tunnel syndrome: randomised “sham” controlled trial.
        BMJ. 1998; 316: 731-735
        • Bakhtiary A.H.
        • Rashidy-Pour A.
        Ultrasound and laser therapy in the treatment of carpal tunnel syndrome.
        Aust J Physiother. 2004; 50: 147-151
        • Michlovitz S.
        • Hun L.
        • Erasala G.N.
        • Hengehold D.A.
        • Weingand K.W.
        Continuous low-level heat wrap therapy is effective for treating wrist pain.
        Arch Phys Med Rehabil. 2004; 85: 1409-1416
        • Hui A.C.
        • Wong S.M.
        • Wong K.S.
        • Li E.
        • Kay R.
        • Yung P.
        • et al.
        Oral steroid in the treatment of carpal tunnel syndrome.
        Ann Rheum Dis. 2001; 60: 813-814
        • Chang M.H.
        • Chiang H.T.
        • Lee S.S.
        • Ger L.P.
        • Lo Y.K.
        Oral drug of choice in carpal tunnel syndrome.
        Neurology. 1998; 51: 390-393
        • Richards R.N.
        Short-term corticosteroids and avascular necrosis: medical and legal realities.
        Cutis. 2007; 80: 343-348
        • Armstrong T.
        • Devor W.
        • Borschel L.
        • Contreras R.
        Intracarpal steroid injection is safe and effective for short-term management of carpal tunnel syndrome.
        Muscle Nerve. 2004; 29: 82-88
        • Dammers J.W.
        • Roos Y.
        • Veering M.M.
        • Vermeulen M.
        Injection with methylprednisolone in patients with carpal tunnel syndrome: a randomized double blind trial testing three different doses.
        J Neurol. 2006; 253: 574-577
        • Wong S.M.
        • Hui A.C.
        • Lo S.K.
        • Chiu J.H.
        • Poon W.F.
        • Wong L.
        Single vs two steroid injections for carpal tunnel syndrome: a randomised clinical trial.
        Int J Clin Pract. 2005; 59: 1417-1421
        • Ozdoăn H.
        • Yazici H.
        The efficacy of local steroid injections in idiopathic carpal tunnel syndrome.
        Br J Rheumatol. 1984; 23: 272-275
        • Ucan H.
        • Yagci I.
        • Yilmaz L.
        • Yagmurlu F.
        • Keskin D.
        • Bodur H.
        Comparison of splinting, splinting plus local steroid injection and open carpal tunnel release outcomes in idiopathic carpal tunnel syndrome.
        Rheumatol Int. 2006; 27: 45-51
        • Spooner G.R.
        • Desai H.B.
        • Angel J.F.
        • Reeder B.A.
        • Donat J.R.
        Using pyridoxine to treat carpal tunnel syndrome.
        Can Fam Physician. 1993; 39: 2122-2127
        • Graham B.
        • Dvali L.
        • Regehr G.
        • Wright J.G.
        Variations in diagnostic criteria for carpal tunnel syndrome among Ontario specialists.
        Am J Ind Med. 2006; 49: 8-13
        • Graham B.
        • Regehr G.
        • Naglie G.
        • Wright J.G.
        Development and validation of diagnostic criteria for carpal tunnel syndrome.
        J Hand Surg. 2006; 31A: 919-924
        • Levine D.W.
        • Simmons B.P.
        • Koris M.J.
        • Daltroy L.H.
        • Hohl G.G.
        • Fossel A.H.
        • et al.
        A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome.
        J Bone Joint Surg. 1993; 75A: 1585-1592