Review ArticleSystematic Reviews

What Can Family Physicians Offer Patients With Carpal Tunnel Syndrome Other Than Surgery? A Systematic Review of Nonsurgical Management

Felicity Goodyear-Smith and Bruce Arroll
The Annals of Family Medicine May 2004, 2 (3) 267-273; DOI: https://doi.org/10.1370/afm.21

Article Figures & Data

Tables

  • Table 1.

    Quality Scores of Studies in Systematic Review

    Scores in PEDro Scale*
    Author1234567891011Total Score γ
    γ The total score is determined by counting the number of criteria that are satisfied, except that scale item I is not used to generate the total score, giving a total score out of 10.
    + Indicates the criterion was clearly satisfied; − indicates that it was not; ? indicates that it is unclear whether criterion was satisfied.
    Aigner & Fielka, 199814−+??+????+−3
    Carter et al, 200215+++++++−?++8
    Chang et al, 199816++++++++?+−8
    Dammers et al, 199917++?++++++++9
    Davis et al, 199818++−+−−−−+++5
    Ebenbichler et al, 199819++?+++?−+++7
    Elbaz et al, 199420−+?++++??+?6
    Garfinkel et al, 199821++++?−+−−+−5
    Herskovitz et al, 199522++?++++−−+−6
    O’Gradaigh & Merry, 200023++?++?−??+−4
    Ozdogan & Yazici, 198424++?++++−?++7
    Oztas et al, 199825++?++????++5
    Spooner et al, 199327++?+++++?++8
    Stransky et al, 198928−+??+??+?−−3
    Walker et al, 200029++?+−−−−?++5
    Wong et al, 200130+++++++++++10
    * Column numbers correspond to the following on the PEDro scale:

    1. Eligibility criteria were specified.

    2. Subjects were randomly allocated to groups.

    3. Allocation was concealed.

    4. Groups were similar at baseline.

    5. Subjects were blinded.

    6. Practitioners who administered the intervention were blinded.

    7. Assessors were blinded.

    8. Measurements of key outcomes were obtained from >85% of subjects.

    9. Data were analyzed by intention to treat.

    10. Statistical comparisons between groups were conducted.

    11. Point measures and measures of variability were provided.

  • Table 2.

    Effective Nonsurgical Treatments for Carpal Tunnel Syndrome

    TreatmentInitial SuccessLong-Term SuccessEvidenceAdvantagesDisadvantages
    Local corticosteroid injection20/24 (86%) respondedWithin 1 year, 50% required surgerySystematic review33; 4 RCTs17,20,23,24Effective symptom relief; some patients may not progress to surgeryLocal steroid affords only temporary relief
    Oral steroidSignificant short-term symptom reductionUnknown2 RCTs16,22Effective short-term symptom relief; some patients may not progress to surgeryPotential adverse reactions to oral corticosteroids
    Waning of effect over 8 weeks
    Less effective than steroid injection30
  • Table 3.

    Possibly Effective Nonsurgical Treatments for Carpal Tunnel Syndrome

    TreatmentInitial SuccessLong-Term SuccessEvidenceAdvantagesDisadvantages
    RCT = randomized controlled trial; NNT = number needed to treat.
    Laser-acupunctureReduction in night pain but not paraesthesiaUnknown1 poor-quality RCT14Possible preoperative analgesic agentPoor availability
    Nerve and tendon gliding exercisesNo significant difference for Phalen’s or Tinel’s sign, or nerve conduction studiesSignificantly reduced rates of surgeryBefore-and-after study using historical controls26NoninvasiveReduced surgical rates may result from confounders
    NNT = 4
    UltrasoundOne study suggested improvement in both symptoms and nerve conduction studies19; other study found no significant difference25Unknown2 RCTs19,25NoninvasiveExpensive
    Conflicting evidenceHigh dropout rate
    Wrist splintingNeutral superior to 20o extension splintingUnknown1 systematic review35 plus 1 RCT19No harmful effects notedPoor compliance
    Full-time use significantly greater improvement in nerve conduction studies but no difference in symptomsAll studies had methodological flaws
    YogaSignificant improvement in Phalen’s sign, grip strength, and pain reduction but not Tinel’s sign, sleep disturbance, or nerve conduction studiesUnknownRCT (single-blind)21NoninvasiveNo changes in nerve conduction studies
    Can be home-based treatment
    Involves high level of patient commitment
    Control group had wrist splinting.
  • Table 4.

    Probably Ineffective Nonsurgical Treatment of Carpal Tunnel Syndrome

    TreatmentEvidenceFindings
    NSAID = nonsteriodal anti-inflammatory drug; RCT = randomized controlled trial.
    NSAID2 RCTs16,18No significant reduction in symptom measures
    Diuretic1 RCT16No significant reduction in symptom measures from baseline to 4th week assessment
    Pyridoxine2 RCTs27,28Reduced finger swelling and discomfort after movement but no difference in nocturnal pain, numbness, Phalen’s or Tinel’s signs or nerve conduction studies in one study, and no significant difference in the other study
    Chiropractic treatment1 RCT18No significant reduction in symptom measures
    Magnet therapy1 RCT15No difference in effect between magnet and placebo

Additional Files

  • Supplemental Appendixes

    Appendix 1: Study methods; Appendix 2: SIGN Revised grading system for recommendations in evidence-based clinical guidelines; Appendix 3: Study outcomes

    Files in this Data Supplement:

  • The Article in Brief

    Carpal tunnel syndrome, which involves pressure on the median nerve in the wrist, can result in numbness, weakness, and pain in the hand or arm. In about half of cases, symptoms go away without treatment. Medications called corticosteroids have been shown to be provide short-term relief for people with carpal tunnel syndrome. Corticosteroids, however, have possible side effects. Surgery can be very effective in treating carpal tunnel syndrome, especially if it is done early in the course of the condition.

Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools
Get Permissions

Jump to section

Subjects