New treatment guidelines for carpal tunnel syndrome

Oct 27 2008

The American Academy of Orthopaedic Surgeons (AAOS) has approved and released an evidence-based clinical practice guideline on "The Treatment of Carpal Tunnel Syndrome."

"Carpal Tunnel Syndrome, otherwise known as CTS, is among the most common disorders of the upper extremity. It affects up to ten percent of the population and is related to many factors, but is thought to be caused by increased pressure on the median nerve in the carpal tunnel in the wrist," said Michael Keith, M.D., Chair of the AAOS work group responsible for creating the new guideline.

• According to the National Center for Health Statistics, in 2005, an estimated 3.1 million people sought help from physicians for the treatment of CTS.

"The Academy created this clinical practice guideline to improve patient care for those suffering from Carpal Tunnel Syndrome," stated Dr. Keith. "The document serves as a point of reference and educational tool for both family practitioners and orthopaedic surgeons, streamlining possible treatment processes for this ever-so common ailment."

In June 2007, the Journal of the Academy of Orthopaedic Surgeons (JAAOS) reported about 500,000 CTS surgical procedures are performed each year. The same study also reported the economic impact due to CTS is estimated to exceed $2 billion annually.

The final CTS Treatment guideline contains nine recommendations which include both operative and non-operative treatment options as well as alternative techniques. Some of the recommendations include:

• Traditional bracing or splinting
• Local steroid injection
• Oral steroids
• Ultrasound
• Carpal tunnel release surgery

After doing a thorough analysis of the current literature, the work group found no evidence that supports the following treatments:

• Heat therapy
• Acupuncture
• Diuretics
• Electric stimulation
• Massage therapy
• Magnet therapy
• Nutritional supplements

"This guideline is not intended to stand alone," added Dr. Keith. "It can be used as a starting point for physicians and can open up the lines of patient-physician communication on possible treatment options."

As new research, knowledge and literature on CTS becomes available, this guideline will be reviewed and re-evaluated by the Guidelines and Technology Oversight Committee. It will be considered for updating in three to five years, which is consistent with evidence-based standards.

The AAOS has released other evidence-based guidelines on musculoskeletal topics, including:

• Diagnosis of Carpal Tunnel Syndrome
• Prevention of Symptomatic Pulmonary Embolism (PE).

This guideline, which is aimed towards the treatment of Carpal Tunnel Syndrome in adults, was developed by an AAOS physician volunteer work group and was based upon a systematic review of the current scientific and clinical information on accepted approaches to treatment and/or diagnosis. The entire process from beginning to end lasted about eighteen months and included a review panel consisting of internal and external committees, public commentaries and final approval by the AAOS Board of Directors.