More than 50% of patients with CTS respond well to conservative treatment, although symptoms may recur, particularly for patient’s with WRCTS. Splinting and local corticosteroid injections show the greatest efficacy balanced by the fewest adverse effects. Additionally, physical and/or occupational therapy may be considered to assist with the manufacture of custom splints, workplace modification, and restoring functional capabilities. Of course management of WRCTS should also include cessation or reduction of provocative occupational exposures. The remaining conservative measures are difficult to fully evaluate because evidence is lacking. Patients that are treated conservatively should be followed up at least monthly until their symptoms improve and stabilize. Furthermore, patient education is an important component of any management plan since it improves patient outcomes and contributes to secondary prevention.
Despite the highly disabling and costly nature of WRCTS, there have been few studies which have evaluated the efficacy of conservative modalities for WRCTS. One study demonstrated that patients with the mildest symptoms had the poorest post-operative results1, suggesting that conservative treatment may provide more benefit to patients with mild symptoms than surgery would. Therefore conservative measures should always be considered.
Conservative treatment options
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Despite the highly disabling and costly nature of WRCTS, there have been few studies which have evaluated the efficacy of conservative modalities for WRCTS. One study demonstrated that patients with the mildest symptoms had the poorest post-operative results1, suggesting that conservative treatment may provide more benefit to patients with mild symptoms than surgery would. Therefore conservative measures should always be considered.
Conservative treatment options
- Splinting
- Corticosteroids
- Patient education
- Task modification
- Rest
- ? Nerve and tendon gliding exercises ?
- ? Therapeutic ultrasound ?
- ? Massage therapy ?
- ? Acupuncture ?
- ? Non-steroidal anti-inflammatories (NSAIDs) ?
- ? Diuretics ?
- ? Pyridoxine (Vitamin B12) ?
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