Non-Surgical Management and Post-Surgical Rehabilitation of Carpal Tunnel Syndrome: An Algorithmic Approach and Practical Guideline

Abstract

: One of the most common forms of entrapment neuropathy is Carpal Tunnel Syndrome (CTS). There are various treatment options for CTS. However, there are no clear and structured guidelines. This review classified the existing treatments and developed an algorithm to help physicians to choose the best option for their patients. Treatment options were summarized in three sections: non-surgical management of CTS, post-operative management of CTS, and practical open carpal tunnel release post-op protocol. The physicians can prescribe multiple treatment options to CTS patients. Corticosteroid in oral or injectable form has strong evidence in pain control and functional improvement in the short term. Shockwave therapy and nocturnal wrist splints display moderate therapeutic effects. Post carpal tunnel release rehabilitation can be started a few days after the operation.

Sensory Nerve Conduction Velocity Predicts Improvement of Hand Function with Nerve Gliding Exercise Following Carpal Tunnel Release Surgery

“…This study used the NGE method by Nazarieh et al [34]. Procedures for conducting an NGE (position 1: wrist in neutral and fingers and thumb in flexion; position 2: wrist in neutral and fingers and thumb extended; position 3: thumb in neutral and wrist and fingers extended; position 4: wrist, fingers, and thumb extended: position 5, the same as position 4 with the forearm in supination (palm up); and position 6: same as position 5 with the other hand gently stretching the thumb) were observed (Figure 1).…”

“…Nerve gliding exercise has six movements depending on the position of the wrist joint and fingers [34].…”

Medical Rehabilitation Management of Carpal Tunnel Syndrome

“…Terapi latihan direkomendasikan untuk CTS derajat ringan dan sedang atau menunggu operasi. Latihan menurunkan tekanan intrakarpal dan inflamasi, juga memperbaiki arus balik vena dengan cara menurunkan edema dan adesi (20). Latihan yang paling sering dilakukan untuk CTS adalah median nerve glide mobilization dan tendon glide (Gambar 1 dan 2) (21).…”

“…Mempertahankan posisi netral pergelangan tangan memperbaiki sirkulasi darah sehingga menurunkan edema (17). Latihan yang dianjurkan satu sampai lima kali per hari dengan 5 -10 repetisi (20).…”

“…Efek non termal meliputi kavitasi, massage yang dapat memicu efek anti-inflamasi dan rangsangan jaringan (22). Beberapa penelitian terapi ultrasound menunjukkan efek positif pada CTS (23), terutama ditambah ortesa pergelangan tangan (22), namun menurut Cochrane review kualitas terapi ultrasound dibandingkan placebo jelek pada jangka pendek dan jangka panjang (20). Latihan neural mobilization saraf medianus lebih efektif dibandingkan terapi ultrasound (24).…”