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.