Medical management: Non-surgical treatment comprises of;
· Oral steroids
· Corticosteroid injections
· Vitamin B6
· Splinting/ hand brace.
All of these have limited to moderate evidence of effectiveness. Surgical treatment seems to be more effective than splinting and NSAIDS. Two main methods to decompress the median nerve by surgery are;
· Open carpal tunnel release (OCTR)
· Endoscopic carpal tunnel release (ECTR)
Physical therapy management: Patients with mild to moderate symptoms do not need to be immediately operated but can be effectively treated in a primary care environment.
Physical therapy typically consists of;
· Modification of activities and workplace
· Patient education
· Carpal bone and nerve mobilization
· Electromagnetic field therapy
It is important for a physiotherapist to pay attention to the cause of CTS. Physical therapist should give advice in task modification like taking sufficient rest and variation of movements.
Patients may benefit from physiotherapy-based treatment with goals of CTS symptom reduction and functional gains, provided that:
Their symptoms are intermittent and not rapidly worsening or if their CTS etiology is highly suggestive of the possibility of remission as an example of pregnancy-related CTS
Patients are informed about the lack of high-quality evidence for the effectiveness and safety of therapeutic modalities used by physiotherapists.