The Annals of Family Medicine

www.annfammed.org

doi: 10.1370/afm.21
Ann Fam Med May 1, 2004 vol. 2 no. 3 267-273

The Annals of Family Medicine

www.annfammed.org

doi: 10.1370/afm.21
Ann Fam Med May 1, 2004 vol. 2 no. 3 267-273

What Can Family Physicians Offer

Patients With Carpal Tunnel Syndrome
Other Than Surgery? A Systematic Review
of Nonsurgical Management
Felicity Goodyear-Smith, MB, ChB, MGP and Bruce Arroll, MB, ChB, PhD

+ Author Affiliations

+ Author Affiliations

CORRESPONDING AUTHOR: Felicity Goodyear-Smith, MB, ChB, MGP, Department

of General Practice & Primary, Health Care, Faculty of Medical & Health Sciences,
University of Auckland, Private Bag 92019, Auckland, New Zealand, f.goodyear-
smith@auckland.ac.nz

Abstract

BACKGROUND We undertook a literature review to produce evidence-based

recommendations for nonsurgical family physician management of carpal tunnel
syndrome (CTS).

METHODS Study design was systematic review of randomized controlled trials (RCTs)
on CTS treatment. Data sources were English publications from all relevant
databases, hand searches, and guidelines. Outcomes measured were nonsurgical
management options for CTS.

RESULTS We assessed 2 systematic reviews, 16 RCTs, and 1 before-and-after study

using historical controls. A considerable percentage of CTS resolves spontaneously.
There is strong evidence that local corticosteroid injections, and to a lesser extent oral
corticosteroids, give short-term relief for CTS sufferers. There is limited evidence to
indicate that splinting, laser-acupuncture, yoga, and therapeutic ultrasound may be
effective in the short to medium term (up to 6 months). The evidence for nerve and
tendon gliding exercises is even more tentative. The evidence does not support the
use of nonsteroidal ant-iinflammatory drugs, diuretics, pyridoxine (vitamin B6),
chiropractic treatment, or magnet treatment.

CONCLUSIONS For those who are not able to get surgery or for those who do not
want surgery, there are some conservative modalities that can be tried. These
modalities include ones for which there is good evidence. It would be reasonable to try
some of the techniques with less evidence if the better ones are not successful.
Reconsideration of surgery must always be kept in mind to avoid permanent nerve
damage.

Key Words:
Carpal tunnel syndrome
preoperative care
review literature

Received for publication October 2, 2002.

Revision received March 20, 2003.
Accepted for publication April 22, 2003.

© 2004 Annals of Family Medicine, Inc.

TRACK Comments:
Margaret A Naeser
Laser Acupuncture and Microamps TENS, Controlled Study and
Open Protocol Study
Ann Fam Med published online June 2, 2004
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