Research: GOODYEAR-SMITH and ARROLL,

Listed in Issue 109

Abstract

GOODYEAR-SMITH and ARROLL, Department of General Practice & Primary Health Care, Faculty of Medical & Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand f.goodyear-smith@auckland.ac.nz, have reviewed (48 references) the nonsurgical management of carpal tunnel syndrome.

Background

A literature review was conducted with the aim to produce evidence-based recommendations for nonsurgical GP management of carpal tunnel syndrome.

Methodology

A systematic review of randomized controlled trials on carpal tunnel syndrome treatment was carried out. Data sources were English publications from all relevant databases, hand searches, and guidelines. Outcomes measured were nonsurgical management options for carpal runnel syndrome.

Results

2 systematic reviews, 16 randomized controlled trials, and 1 before-and-after study using historical controls were included. A considerable percentage of carpal tunnel syndrome resolves spontaneously. There is strong evidence that local corticosteroid injections, and to a lesser extent oral corticosteroids, give short-term relief for sufferers. There is limited evidence to indicate that splinting, laser-acupuncture, yoga, and therapeutic ultrasound may be effective in the short to medium term (up to 6 months). The evidence for nerve and tendon gliding exercises is more tentative. The evidence does not support the use of nonsteroidal anti-inflammatory drugs, diuretics, pyridoxine (vitamin B6), chiropractic treatment, or magnet treatment.

Conclusion

For those who are not able to get surgery, or for those who do not want surgery, there are some conservative modalities that can be tried. These modalities include ones for which there is good evidence. It would be reasonable to try some of the techniques with less evidence if the better ones are not successful. Reconsideration of surgery must always be kept in mind to avoid permanent nerve damage.

References

Goodyear-Smith F, Arroll B. What can family physicians offer patients with carpal tunnel syndrome other than surgery? A systematic review of nonsurgical management. Annals of Family Medicine 2(3): 267-273, May-Jun 2004.

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