Treatment and Prognosis
Treatment falls into two categories:
Conservative
- A volar splint, placed in a neutral position, has been shown to result in a statistically significant decrease in symptoms compared with controls. Initial success rate is up to 70% but this falls over two to three years to 12-30%
- Studies for two weeks of ultrasound treatment showed no benefit
- There is no data demonstrating the superiority of NSAIDs over placebo
- Corticosteroid injections are beneficial for one month, but their benefit beyond one month is unclear
- Diuretics have not been show to be beneficial
Surgery
Definitive therapy consists of surgical release of the transverse carpal ligament.
Surgery relieves symptoms significantly better than splints.
A Cochrane review found that endoscopic surgery results in more transient nerve problems, while open surgery has more wound problems.
Surgery for CTS has a long-term success rate >75%.
The prognosis for this condition following treatment is outlined below:
Prognosis
Prognosis is excellent with definitive therapy.
During pregnancy, CTS has a more benign course with fewer cases requiring surgical treatment.
Risk factors for poorer than average prognosis include the following:
- Advanced disease
- Atypical symptoms (normal nerve conduction studies, symptoms in fifth digit)
- Longer symptom duration
- Older age
- Coexisting disease (diabetes, other peripheral neuropathy)
- Heavy manual occupation
Despite treatment, some patients may have residual fingertip numbness.