Current approaches for carpel tunnel syndrome

Spontaneous improvement is possible

A single corticosteroid injection in the wrist can offer at least a month of relief and possibly avoid surgery for carpal tunnel syndrome sufferers, according to an updated review of a dozen studies with 671 participants by Canadian researchers.1

Local injections are the most effective nonsurgical remedy for carpal tunnel, said Shawn Marshall, MD, a specialist in physical medicine and rehabilitation at the University of Ottawa and lead author of the review. "One of the goals is to avoid surgery," Marshall adds.

Two studies showed that patients improved significantly within a month of receiving a local corticosteroid injection, when compared to receiving a placebo. Another study found greater improvement among those who received the injection as long as three months after treatment. "There's building evidence to suggest that it works beyond one month," Marshall says.

According to Marshall, the take-home message for occupational health nurses is: Using less aggressive and more conservative initial measures for treatment of carpal tunnel syndrome before surgical intervention is a reasonable approach. For example, an employee might first try wrist splinting at night and then consider local steroid injection, which has a quick time onset for effectiveness.

Marshall also points to evidence showing that a significant percentage of persons with carpal tunnel syndrome improve spontaneously.2

Carpal tunnel syndrome is treated conservatively first, including night time splinting, and sometimes an anti-inflammatory medication, says Kurt T. Hegmann, MD, MPH, director of the Salt Lake City, UT-based Rocky Mountain Center for Occupational & Environmental Health. "If that does not work, we are increasingly using cortisone injections as the next best step," says Hegmann. "They both help assure us of the diagnosis as well as treat the condition, with most people having at least a year of benefit and many having up to several years of benefit."

Many practitioners omit this step and instead order a nerve conduction study, says Hegmann. "However for the above reasons, I suspect that this is not the optimal approach," he says. "Surgery is used for those who fail to respond to conservative treatment, especially the more severely affected, who do better than those with milder symptoms."

Regardless of the medical or surgical treatment received, the overall treatment plan should include an ergonomic assessment of the workplace with the goal of reducing the risk of a repetitive strain injury, says Marshall. "Occupational health professionals should also consider modifying the work environment to avoid aggravating factors such as high force, high repetition activities that can contribute to carpal tunnel syndrome," he adds.

References

1. Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Systematic Reviews 2007, Issue 2. Art. No.: CD001554. DOI: 10.1002/14651858.CD001554.pub2.

2. Padua L, Padua R, Aprile I. Multiperspective follow-up of untreated carpal tunnel syndrome: A multicenter study. Neurology 2001; 56:1,459-1,466.

Sources

For more information on carpal tunnel syndrome, contact:

  • Kurt T. Hegmann, MD, MPH, Director, Rocky Mountain Center for Occupational & Environmental Health, 391 Chipeta Way, Suite C, Salt Lake City, UT 84108. Phone: (801) 581-8719. E-mail: kurt.hegmann@hsc.utah.edu.
  • Shawn Marshall, MD, Associate Professor, Department of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario. E-mail: smarshall@Ottawahospital.on.ca.