Is there Light at the End of the Tunnel? Controversies in the Diagnosis and Management of Carpal Tunnel Syndrome

Abstract

Carpal tunnel syndrome is a common disorder responsible for considerable patient suffering and cost to health services. Despite extensive research, controversies still exist with regards to best practice in diagnosis, treatment, and service provision. Current best practise would support the use of history, examination and electro-diagnostic studies. The role for ultrasound scanning in diagnosis of carpal tunnel syndrome is yet to be proven. It appears magnetic resonance image scanning has a role where a rare cause for carpal tunnel syndrome may be suspected and also in the detailed reconstruction of the anatomy to aid endoscopic procedures. Treatment options can be surgical or non-surgical and patient choice will dictate the decision. For non-surgical interventions many options have been trialled but until now only steroid use, acupuncture, and splinting have shown discernable benefits. Open surgical decompression of the carpal tunnel appears to be more simple and cost-effective than minimally invasive interventions. For those patients who reject surgery, splinting, acupuncture, and steroid injection can play a role. Recent work looking at different service delivery options has shown some positive results in terms of decreasing patient waiting time for definitive treatment. However, no formal cost-effectiveness analysis has been published and concerns exist about the impact of a stream-lined service on surgical training. In this review, we look at the different diagnostic and treatment options for managing carpal tunnel syndrome. We then consider the different service delivery options and finally the cost-effectiveness evidence.

Similar effectiveness of the open versus endoscopic technique for carpal tunnel syndrome: a prospective randomized trial

“…Conservative or surgical methods are applied in the treatment of CTS. Conservative treatments are primarily preferred in Stages 1 and 2 [4]. Surgical methods are used on Stage 1 and Stage 2 patients who do not benefit from physical treatment and on patients after Stage 3 [5].…”

Nociceptive and Histomorphometric Evaluation of Neural Mobilization in Experimental Injury of the Median Nerve

“…Prime et al [7] assert that, besides the direct economic consequences, one must take into account the financial implications and indirect load of absenteeism in the workplace. On average, workers affected by CTS remain about 27 days away from their professional duties.…”

Local steroid injection versus wrist splinting for carpal tunnel syndrome: A randomized clinical trial

“…In the USA, between 400 000 and 500 000 patients underwent surgical decompression annually which equates to an economic cost of in excess of $2 billion. 1 CTS was found to account for more morbidity, measured by cases and working days lost, than any other illness in the US working population. 3 CTS may also occur as a work-related disorder leading to compensation claims.…”

“…The prevalence of CTS in the UK is 7-16%. 1 Its incidence has been estimated at 88-125 per 100 000 in the USA. 2 Economic consequences include the direct financial implications of treatment and the indirect cost of absenteeism from the workplace.…”