AAOS Updates Clinical Practice Guideline for Carpal Tunnel Syndrome
The American Academy of Orthopaedic Surgeons (AAOS) has released an updated clinical practice guideline (CPG) for treating carpal tunnel syndrome (CTS). The updated guideline provides evidence-based recommendations to help healthcare providers make informed decisions regarding the diagnosis and treatment of this common condition.
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome (CTS) is a condition that causes numbness, tingling, and weakness in the hand and arm. It occurs when the median nerve, which runs from the forearm into the hand, becomes compressed at the wrist within the carpal tunnel. The carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of the wrist.
Causes and Risk Factors
The exact cause of CTS is often unknown, but several factors can contribute to its development, including:
- Repetitive hand movements
- Forceful exertion of the hand
- Awkward hand postures
- Vibration exposure
- Underlying medical conditions such as diabetes, rheumatoid arthritis, and hypothyroidism
- Pregnancy
- Obesity
- Family history of CTS
Symptoms of Carpal Tunnel Syndrome
The symptoms of CTS typically start gradually and worsen over time. Common symptoms include:
- Numbness or tingling in the thumb, index, middle, and part of the ring finger
- Pain in the hand and wrist, which may radiate up the arm
- Weakness in the hand, making it difficult to grip objects
- Symptoms that are often worse at night or early morning
- Clumsiness and difficulty with fine motor skills, such as buttoning clothes
Diagnosis of Carpal Tunnel Syndrome
Diagnosing CTS typically involves a combination of:
- Physical examination: A thorough evaluation of your medical history, symptoms, and physical examination of your hand, wrist, arm, and neck. The doctor will check for numbness, weakness, muscle atrophy, and other signs of nerve compression.
- Nerve conduction studies (NCS) and electromyography (EMG): Electrodiagnostic tests like NCS and EMG measure the electrical activity of the median nerve and muscles in your hand and forearm.
- Imaging tests: While not routinely needed, X-rays, ultrasounds, or MRI scans may be ordered to rule out other conditions or visualize the carpal tunnel structure.
Non-Surgical Treatment Options
The initial treatment for CTS is often non-surgical and may include:
- Activity Modification: Identify and avoid activities that aggravate your symptoms. Take frequent breaks from repetitive hand movements.
- Wrist Splinting: Wearing a splint, especially at night, can help keep the wrist in a neutral position, reducing pressure on the median nerve.
- Medications: Over-the-counter or prescribed pain relievers, such as ibuprofen or naproxen, can help reduce pain and inflammation. Corticosteroid injections into the carpal tunnel can provide temporary relief from symptoms but are not a long-term solution.
- Physical Therapy: A therapist can teach you exercises to strengthen hand and wrist muscles, improve flexibility, and reduce nerve compression.
Surgical Treatment Options
If non-surgical treatments fail to provide adequate relief, or if there is evidence of significant nerve compression, surgery may be recommended. Carpal tunnel release surgery aims to relieve pressure on the median nerve by cutting the transverse carpal ligament.
There are two main surgical approaches:
- Open Carpal Tunnel Release: This traditional approach involves a larger incision in the palm of your hand, allowing the surgeon to directly visualize and cut the ligament.
- Endoscopic Carpal Tunnel Release: This minimally invasive technique uses a smaller incision and an endoscope (a thin tube with a camera) to guide the surgery.
AAOS Clinical Practice Guideline Recommendations
The updated AAOS CPG provides 11 recommendations based on a comprehensive review of current evidence. Some key recommendations include:
- Electrodiagnostic testing (NCS/EMG) should be used to confirm the diagnosis of CTS before surgical treatment.
- Patients with mild to moderate CTS should be offered non-surgical treatment options, such as wrist splinting or corticosteroid injections.
- Surgery should be considered for patients with severe CTS or those who do not respond to non-surgical treatment.
- Both open and endoscopic carpal tunnel release are effective surgical treatments for CTS, and the choice of procedure should be based on the surgeon’s experience and the patient’s individual factors.
Post-Treatment Care and Recovery
Following treatment, whether surgical or non-surgical, it is important to follow your healthcare provider’s instructions for post-treatment care. This may include:
- Wound care (if applicable)
- Hand therapy to regain strength, flexibility, and coordination
- Activity modification to avoid activities that may strain the healing tissues
- Gradual return to normal activities as tolerated
Prevention of Carpal Tunnel Syndrome
While not all cases of CTS are preventable, there are steps you can take to reduce your risk:
- Take breaks from repetitive hand movements, allowing your hands to rest.
- Use ergonomic tools and equipment designed to reduce strain on your wrists.
- Maintain a healthy weight to reduce pressure on nerves.
- Manage underlying medical conditions that can contribute to CTS.
Conclusion
The updated AAOS CPG provides healthcare professionals with valuable guidance on the diagnosis and management of carpal tunnel syndrome. By following these evidence-based recommendations, healthcare providers can help patients achieve the best possible outcomes and improve their quality of life. It is important to remember that individual treatment plans should be tailored to each patient’s specific needs and preferences. If you are experiencing symptoms of carpal tunnel syndrome, seek medical attention from a qualified healthcare professional for an accurate diagnosis and personalized treatment plan.