Comprehensive Review on the Medical Management of Carpal Tunnel Syndrome

Dr Neeraj Manikath;Claude.ai

Abstract

Carpal tunnel syndrome (CTS) represents the most common entrapment neuropathy, affecting approximately 3-6% of adults in the general population. This review examines the current evidence for non-surgical management approaches to CTS, emphasizing their efficacy, limitations, and optimal implementation in clinical practice. Despite the frequency of surgical intervention, medical management remains the first-line approach for mild to moderate cases, offering significant symptomatic relief and functional improvement for many patients. This review synthesizes current evidence regarding conservative treatment modalities, including splinting, corticosteroid injections, oral medications, physical therapy interventions, and emerging therapeutic options, providing clinicians with an evidence-based framework for the comprehensive medical management of CTS.

Introduction

Carpal tunnel syndrome (CTS) stands as the most prevalent peripheral nerve entrapment neuropathy in clinical practice, characterized by compression of the median nerve as it traverses the carpal tunnel at the wrist. Global prevalence estimates range from 1-5% in the general population, with incidence rates between 1-3 per 1000 person-years. The condition demonstrates a marked gender disparity, affecting women approximately three times more frequently than men, with peak incidence occurring between 40-60 years of age.

The socioeconomic impact of CTS is substantial, with annual economic costs in the United States alone estimated at $2 billion, primarily attributable to surgical intervention, lost productivity, and disability claims. Beyond economic considerations, CTS significantly impairs quality of life, with patients reporting disruptions in sleep, daily activities, and occupational performance. The condition accounts for approximately 2 million physician visits annually in the US and represents a leading cause of work-related disability claims.

The management paradigm for CTS has evolved considerably in recent decades, with growing emphasis on evidence-based conservative approaches before considering surgical intervention. This review aims to provide a comprehensive analysis of current medical management strategies, their clinical efficacy, and practical implementation considerations for the practicing clinician.

Etiology and Risk Factors

Pathophysiological Mechanisms

The pathophysiology of CTS centers on increased pressure within the carpal tunnel leading to mechanical compression, vascular compromise, and inflammatory changes affecting the median nerve. This compression results in altered nerve microcirculation, endoneurial edema, and, in chronic cases, demyelination and axonal loss. The heterogeneity of underlying mechanisms contributes to the variable clinical presentation and treatment response observed in clinical practice.

Risk Factor Classification

Anatomical Factors

Congenitally small carpal tunnel
Ganglion cysts, tumors, or space-occupying lesions
Wrist fractures or dislocations altering carpal tunnel architecture
Thickened transverse carpal ligament

Systemic Conditions

Diabetes mellitus (2-3 fold increased risk)
Hypothyroidism
Rheumatoid arthritis and other inflammatory arthropathies
Amyloidosis
Obesity (BMI >30 associated with 2.5x increased risk)
Pregnancy (particularly third trimester)
Menopause and hormonal fluctuations

Occupational and Behavioral Factors

Repetitive wrist flexion/extension
Prolonged exposure to vibration
Sustained forceful gripping
Prolonged keyboard use with improper ergonomics
Assembly line work requiring repetitive hand movements

Genetic Considerations

Recent genome-wide association studies have identified several genetic loci associated with increased CTS susceptibility, suggesting heritable components to the condition. Family history represents an independent risk factor, with first-degree relatives of affected individuals demonstrating a 2-4 fold increased risk of developing the condition.

Understanding these diverse risk factors facilitates targeted prevention strategies and informs medical management approaches. Risk modification represents a critical component of comprehensive CTS management, particularly for occupational exposures and modifiable systemic conditions.

Diagnostic Approaches

Clinical Presentation

The classic clinical presentation of CTS involves paresthesias and pain in the median nerve distribution (thumb, index, middle, and radial half of the ring finger). Key diagnostic features include:

Nocturnal symptoms awakening patients from sleep (85% sensitivity)
Symptom exacerbation with sustained wrist flexion or extension
Symptom relief with hand shaking or position changes ("flick sign")
Progressive involvement, often beginning with intermittent sensory symptoms and potentially evolving to persistent sensory deficits and thenar muscle weakness/atrophy in advanced cases

Physical Examination Techniques

Several provocative maneuvers assist in diagnosis, though their sensitivity and specificity vary considerably:

Phalen's test: Maximal wrist flexion held for 60 seconds, positive if symptoms reproduced (sensitivity 68%, specificity 73%)
Tinel's sign: Percussion over the median nerve at the wrist, positive if paresthesias elicited in median distribution (sensitivity 50%, specificity 77%)
Durkan's compression test: Direct pressure applied over the carpal tunnel for 30 seconds, positive if symptoms reproduced (sensitivity 87%, specificity 90%)
Hand elevation test: Raising hands above head for 2 minutes, positive if symptoms reproduced (sensitivity 75%, specificity 98%)

Comprehensive examination should include assessment for thenar atrophy, objective sensory testing (two-point discrimination, monofilament testing), and motor strength evaluation of the abductor pollicis brevis.

Electrodiagnostic Studies

Nerve conduction studies (NCS) and electromyography (EMG) remain the gold standard for objective confirmation of CTS, with reported sensitivity of 85-90% and specificity of 95-97%. Key electrodiagnostic findings include:

Prolonged median sensory and motor distal latencies
Reduced sensory nerve action potential (SNAP) and compound muscle action potential (CMAP) amplitudes
Slowed conduction velocity across the carpal tunnel segment
Comparison studies (median vs. ulnar or radial) to detect mild cases
EMG evidence of denervation (fibrillations, positive sharp waves) in severe cases with axonal involvement

The American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) has established standardized criteria for electrodiagnostic grading of CTS severity:

Mild: Sensory nerve abnormalities only, normal motor studies
Moderate: Abnormal sensory studies with prolonged motor distal latency
Severe: Prolonged motor and sensory latencies with either absent SNAP or evidence of axonal loss (reduced CMAP amplitude, EMG abnormalities)

Imaging Modalities

While not routinely required for diagnosis, imaging may provide valuable information in atypical presentations or when structural abnormalities are suspected:

Ultrasound: High-resolution ultrasound demonstrates increased cross-sectional area of the median nerve (>10mm²) at the carpal tunnel inlet, with reported sensitivity and specificity of 78% and 87%, respectively. Advantages include cost-effectiveness, ability to perform dynamic evaluation, and absence of radiation exposure.
Magnetic Resonance Imaging (MRI): Offers superior soft tissue contrast and can identify space-occupying lesions, inflammatory changes, and anatomic variants. Primary findings include median nerve flattening, increased signal intensity, and bowing of the flexor retinaculum. Generally reserved for complex cases or preoperative planning.

A comprehensive diagnostic approach integrating clinical, electrodiagnostic, and selectively employed imaging findings ensures accurate diagnosis and appropriate treatment planning.

Non-Surgical Management

Lifestyle and Ergonomic Modifications

Activity modification represents a cornerstone of initial management, particularly for occupation-related CTS. Key interventions include:

Identifying and minimizing aggravating activities
Implementing regular rest breaks during repetitive tasks (10-minute breaks hourly)
Optimizing workplace ergonomics with neutral wrist positioning
Use of ergonomic computer peripherals (split keyboards, vertical mouse)
Tool modification to reduce grip force requirements
Job rotation to distribute mechanical stresses across different muscle groups

While evidence for these interventions in isolation is limited, incorporating ergonomic principles as part of a comprehensive management approach demonstrates improved outcomes in observational studies.

Splinting Therapy

Wrist splinting represents one of the most extensively studied conservative interventions for CTS, with substantial evidence supporting its efficacy:

Implementation: Neutral wrist position (0-5° extension) consistently demonstrates superior outcomes compared to other positions
Wearing schedule: Nocturnal splinting alone provides significant improvement for mild to moderate CTS (NNT=4 for symptom improvement at 4 weeks)
Continuous vs. intermittent: Full-time splinting may offer additional benefit for severe symptoms, though compliance issues often limit implementation
Duration: Most studies demonstrate maximal benefit within 6-12 weeks, with diminishing returns beyond this timeframe
Comparative efficacy: A 2018 Cochrane review found moderate-quality evidence supporting splinting efficacy comparable to oral steroids in the short term (3 months), with fewer adverse effects

A meta-analysis of 10 randomized controlled trials demonstrated symptom improvement in 37-80% of patients using wrist splints, with greatest efficacy in mild to moderate cases and those with symptoms duration <12 months.

Pharmacological Approaches

Oral Medications

Non-steroidal anti-inflammatory drugs (NSAIDs) Despite widespread use, evidence supporting NSAID efficacy specifically for CTS remains limited. A 2018 systematic review identified only two small randomized controlled trials, neither demonstrating significant benefit over placebo for CTS symptoms. NSAIDs may provide modest analgesic benefit for associated tendinitis or tenosynovitis but demonstrate limited impact on the primary neurogenic symptoms of CTS.

Oral corticosteroids Short-term oral corticosteroid therapy demonstrates moderate evidence of efficacy for temporary symptom relief:

Prednisone 20mg daily for 2 weeks followed by 10mg daily for 2 weeks shows significant symptom improvement compared to placebo (NNT=3 for symptom improvement at 4 weeks)
Benefits typically diminish within 8 weeks of discontinuation
Side effect profile limits long-term utilization

Gabapentinoids Limited evidence suggests potential benefit from gabapentin (300-900mg daily) or pregabalin (150-300mg daily) for neuropathic pain components of CTS. A small randomized trial (n=140) comparing gabapentin versus placebo demonstrated modest improvement in pain scores but not in functional outcomes or neurophysiological parameters.

Vitamin B6 (Pyridoxine) Despite theoretical rationale, randomized controlled trials have failed to demonstrate significant benefit of vitamin B6 supplementation over placebo for CTS symptoms. A 2017 systematic review concluded insufficient evidence to support routine recommendation.

Local Injections

Corticosteroid injections Corticosteroid injection into the carpal tunnel represents one of the most effective non-surgical interventions for short-term symptomatic relief:

Commonly utilized agents include methylprednisolone (20-40mg), triamcinolone (10-40mg), or betamethasone (6mg)
Median duration of benefit ranges from 2-3 months, with approximately 20% of patients reporting sustained benefit at one year
Ultrasound guidance improves accuracy and potentially efficacy compared to landmark-guided injection
Repeated injections demonstrate diminishing returns, with reduced efficacy and duration of benefit
Complication rates are low (1-5%) but include median nerve injury, infection, tendon rupture, and skin/subcutaneous atrophy

A 2018 network meta-analysis of 10 randomized controlled trials (n=633) found local corticosteroid injection superior to placebo, oral steroids, and splinting for short-term symptom relief (1-3 months), though benefits generally equalized by 6 months.

Other injectable therapies

Platelet-rich plasma (PRP): Emerging data suggests potential benefit, with a 2018 randomized trial (n=60) demonstrating comparable efficacy to corticosteroid injection at 3 months with potentially more sustained benefit at 6 months
Hyaluronic acid: Limited evidence with mixed results, a single small RCT showing modest benefit over placebo but inferior to corticosteroid injection
Botulinum toxin: Currently insufficient evidence to support routine use

Physical and Rehabilitative Approaches

Manual therapy techniques

Carpal bone mobilization
Neural gliding exercises
Soft tissue mobilization
Myofascial release techniques

A 2018 systematic review and meta-analysis of manual therapy interventions identified moderate evidence supporting manual therapy combined with multimodal rehabilitation versus no treatment, though insufficient evidence comparing manual therapy to other active interventions.

Therapeutic exercise

Median nerve gliding exercises
Tendon gliding exercises
Progressive resistance training for grip/pinch strength
Stretching of wrist flexors/extensors

A randomized controlled trial by Horng et al. (2011) demonstrated that nerve and tendon gliding exercises combined with splinting provided significantly greater symptom relief than splinting alone at 8-week follow-up.

Physical modalities

Low-level laser therapy (LLLT): Mixed evidence with heterogeneity in treatment parameters. A 2016 meta-analysis of 7 RCTs found modest benefit for pain reduction and grip strength improvement compared to placebo, particularly with 780-860nm wavelength at 9-11J/cm² dosage.
Therapeutic ultrasound: Limited evidence for efficacy. A Cochrane review found insufficient high-quality evidence to support or refute effectiveness.
Iontophoresis: Several small studies suggest potential benefit for dexamethasone iontophoresis, though results are inconsistent and methodology often limited.

Alternative and Complementary Approaches

Acupuncture A 2018 systematic review and meta-analysis of 10 randomized controlled trials (n=728) found acupuncture superior to steroid injection and vitamin B12 for symptom improvement at 4 weeks, with comparable efficacy to splinting. Methodological limitations in many included studies temper these findings.

Yoga A notable randomized trial by Garfinkel et al. demonstrated an 8-week yoga-based intervention focusing on upper body postures significantly improved pain, grip strength, and Phalen sign compared to wrist splinting alone. Further large-scale studies are needed to confirm these findings.

Curcumin and other nutraceuticals Limited evidence from small trials suggests potential anti-inflammatory benefits from curcumin supplementation (1000mg daily), though further research is needed before routine recommendation.

Recent Advances in Medical Management

Emerging Pharmacological Approaches

Recent research has explored novel pharmacological targets for CTS management, focusing on neuroinflammatory mechanisms and nerve regeneration:

Perineural injection therapy: A technique involving injection of 5% dextrose solution (prolotherapy) around the median nerve. A 2017 randomized trial (n=50) demonstrated significant improvement in pain and function compared to corticosteroid injection at 6-month follow-up, with more sustained benefit.
Nerve growth factors: Experimental models suggest potential for nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) to enhance nerve regeneration after compression injury. Early-phase clinical trials are ongoing.
Topical modulators: Compounded topical preparations combining agents such as ketamine, gabapentin, diclofenac, and lidocaine have shown preliminary promise in small open-label studies, though controlled trials are lacking.

Advanced Splinting and Orthotic Developments

Innovation in splinting technology has yielded several promising developments:

Dynamic splinting systems: Allowing controlled, progressive stretching of the transverse carpal ligament while maintaining functional wrist position. Early clinical testing suggests potentially superior outcomes to static splinting.
Kinesiology taping techniques: A 2017 randomized trial comparing kinesiology taping to night splinting found comparable short-term outcomes for symptom relief, with superior patient satisfaction in the taping group.
3D-printed custom orthoses: Utilizing 3D scanning and printing technology to create precisely fitted orthoses tailored to individual patient anatomy. Preliminary studies report improved comfort and compliance compared to prefabricated options.

Regenerative Medicine Approaches

Emerging evidence suggests potential applications for regenerative medicine in CTS management:

Platelet-rich plasma (PRP): Beyond simple injection, advanced PRP formulations with varying leukocyte concentrations and activation protocols are being investigated. A 2020 randomized trial comparing leukocyte-poor versus leukocyte-rich PRP found superior outcomes with leukocyte-poor formulations.
Mesenchymal stem cells: Preclinical models demonstrate promising nerve regeneration effects following perineural application of mesenchymal stem cells. Phase I/II clinical trials are currently underway.
Extracellular vesicles and exosomes: Representing the paracrine signaling components of stem cells, these cell-free preparations show promising nerve regeneration effects in preclinical models with potentially reduced safety concerns compared to cell-based therapies.

Technologically-Enhanced Rehabilitation

Integration of technology with traditional rehabilitation approaches offers novel treatment paradigms:

Biofeedback training: Surface EMG-guided therapy allowing patients to visualize and modify muscle activation patterns. A small randomized trial demonstrated superior outcomes compared to conventional therapy for pain reduction and function improvement.
Virtual reality rehabilitation: Gamified rehabilitation programs enhancing adherence to therapeutic exercise regimens. Early studies show promising results for patient engagement and satisfaction.
Telerehabilitation: Remote delivery of supervised therapy programs, particularly valuable for patients with limited access to specialized care. Non-inferiority compared to in-person therapy has been demonstrated for several CTS rehabilitation protocols.

Surgical Interventions

While detailed surgical management extends beyond the scope of this review, understanding surgical indications and outcomes provides important context for medical management decisions.

Surgical Techniques

Open carpal tunnel release: Traditional approach with 3-4cm palmar incision, direct visualization and division of the transverse carpal ligament
Endoscopic carpal tunnel release: Single or two-portal techniques allowing division of the transverse carpal ligament via smaller incisions
Mini-open techniques: Hybrid approaches attempting to balance visualization with minimized incision length

Surgical Indications

Evidence-based indications for surgical intervention include:

Severe CTS (based on clinical and electrodiagnostic criteria)
Progressive neurological deficit, particularly thenar muscle weakness/atrophy
Failure of conservative management after 3-6 months of appropriate implementation
Acute CTS associated with trauma or compartment syndrome requiring emergent decompression

Comparative Outcomes

A landmark Cochrane review comparing surgical versus non-surgical management found:

Superior symptom relief and functional improvement with surgery compared to splinting at 6 and 12 months
Surgery superior to steroid injection beyond 6 months, though equivalent or inferior outcomes in the first 3 months
Number needed to treat (NNT) of 4 for significant clinical improvement at one year with surgery versus conservative management
Approximately 70-90% of surgically treated patients report good to excellent outcomes

The decision between continued medical management versus surgical intervention requires shared decision-making incorporating patient preferences, symptom severity, functional impact, and response to conservative measures.

Case Studies and Clinical Trials

Case Study 1: Occupational CTS with Gradual Response to Conservative Management

A 42-year-old female administrative assistant presented with 8-month history of gradually worsening right hand paresthesias affecting the thumb, index, and middle fingers. Symptoms were most pronounced during nighttime and early morning hours, with additional exacerbation during prolonged keyboard use. Physical examination revealed positive Phalen's and Durkan's tests with preserved sensation and motor function. Electrodiagnostic studies confirmed mild CTS with prolonged sensory latencies but normal motor parameters.

Management included:

Nocturnal neutral wrist splinting
Ergonomic workstation modifications
Scheduled hourly micro-breaks with median nerve gliding exercises
Local corticosteroid injection (40mg methylprednisolone) at 6 weeks due to incomplete response

By 12-week follow-up, the patient reported 70% reduction in symptoms with resolution of nocturnal awakenings. She remained asymptomatic at one-year follow-up despite returning to full work duties.

This case illustrates the potential effectiveness of comprehensive conservative management in mild to moderate CTS, particularly with occupational contributing factors and short symptom duration.

Case Study 2: Treatment-Resistant CTS Requiring Surgical Intervention

A 68-year-old male retired carpenter presented with bilateral hand numbness and pain of 18 months duration, right worse than left. He reported constant numbness, progressive thenar weakness affecting daily activities, and minimal response to over-the-counter analgesics. Examination revealed thenar atrophy, diminished two-point discrimination, and abductor pollicis brevis weakness (4/5) on the right. Electrodiagnostic studies demonstrated severe CTS bilaterally with evidence of axonal loss on the right.

Management included:

Full-time neutral wrist splinting
Two sequential corticosteroid injections (8 weeks apart)
Trial of pregabalin with modest impact on neuropathic pain component
Physical therapy including manual therapy and therapeutic exercise

Despite comprehensive conservative management, the patient experienced minimal functional improvement and progressive weakness. He underwent right carpal tunnel release at 6 months, followed by left carpal tunnel release 3 months later, with substantial improvement in symptoms bilaterally.

This case highlights the limitations of medical management in severe CTS, particularly with evidence of axonal involvement and established motor deficits.

Clinical Trial Highlight: Comprehensive Conservative Management

A 2018 randomized controlled trial by Fernández-de-las-Peñas et al. compared three conservative treatment approaches in 120 women with mild to moderate CTS:

Group 1: Manual therapy (including carpal bone mobilization) + nerve gliding exercises
Group 2: Electrophysical modalities (LLLT, ultrasound) + night splinting
Group 3: Combined approach including all interventions

Key findings at 12-month follow-up:

All groups demonstrated significant improvement in pain intensity and function
Group 1 (manual therapy/nerve gliding) and Group 3 (combined approach) showed superior outcomes to Group 2 (electrophysical/splinting)
No significant difference between Groups 1 and 3, suggesting manual therapy combined with nerve gliding may represent the most efficient conservative approach
Surgery rates at 12 months were significantly lower in Groups 1 and 3 (10% and 12%) compared to Group 2 (28%)

This trial highlights the potential for appropriately selected and combined conservative approaches to provide sustained benefit even at extended follow-up, potentially reducing surgical conversion rates.

Conclusion

Medical management of carpal tunnel syndrome encompasses a diverse array of therapeutic modalities, with substantial evidence supporting several conservative approaches, particularly for mild to moderate cases. The highest quality evidence supports:

Neutral wrist splinting, particularly during nighttime
Local corticosteroid injection for short-term symptom relief
Manual therapy combined with nerve/tendon gliding exercises
Comprehensive rehabilitation incorporating ergonomic modification and activity adaptation

The optimal management approach requires individualization based on symptom severity, functional impact, electrodiagnostic findings, and patient preferences. A staged approach typically begins with least invasive modalities (splinting, ergonomic modification) and progresses to more invasive interventions (injection therapy, surgery) based on clinical response. For patients with severe CTS, evidence of axonal involvement, or progressive neurological deficit, earlier consideration of surgical intervention is warranted.

Future research directions should focus on:

Defining optimal combinations and sequencing of conservative interventions
Identifying reliable predictors of response to specific conservative modalities
Developing novel therapeutic approaches targeting neuroinflammation and nerve regeneration
Establishing standardized outcome measures facilitating direct comparison across interventions

While surgical management remains the definitive intervention for many patients with CTS, comprehensive medical management provides effective symptom control and functional improvement for a substantial proportion of patients, particularly those with mild to moderate disease identified early in the clinical course.

References

Atroshi I, Gummesson C, Johnsson R, et al. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282(2):153-158.
Padua L, Coraci D, Erra C, et al. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol. 2016;15(12):1273-1284.
American Academy of Orthopaedic Surgeons. Management of Carpal Tunnel Syndrome Evidence-Based Clinical Practice Guideline. 2016.
Huisstede BM, Randsdorp MS, Coert JH, et al. Carpal tunnel syndrome. Part II: effectiveness of surgical and non-surgical treatments. Arch Phys Med Rehabil. 2010;91(7):1005-1024.
Page MJ, Massy-Westropp N, O'Connor D, Pitt V. Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev. 2012;(7):CD010003.
Chesterton LS, Blagojevic-Bucknall M, Burton C, et al. The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome (INSTINCTS trial): an open-label, parallel group, randomised controlled trial. Lancet. 2018;392(10156):1423-1433.
Fernández-de-las-Peñas C, Ortega-Santiago R, de la Llave-Rincón AI, et al. Manual physical therapy versus surgery for carpal tunnel syndrome: a randomized parallel-group trial. J Pain. 2015;16(11):1087-1094.
Peters S, Page MJ, Coppieters MW, et al. Rehabilitation following carpal tunnel release. Cochrane Database Syst Rev. 2016;(2):CD004158.
Chen PC, Chuang CH, Tu YK, et al. A Bayesian network meta-analysis: Comparing the clinical effectiveness of local corticosteroid injections using different treatment strategies for carpal tunnel syndrome. BMC Musculoskelet Disord. 2015;16:363.
Sonoo M, Menkes DL, Bland JDP, Burke D. Nerve conduction studies and EMG in carpal tunnel syndrome: Do they add value? Clin Neurophysiol Pract. 2018;3:78-88.
Shi Q, MacDermid JC. Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? A systematic review. J Orthop Surg Res. 2011;6:17.
Bilkis S, Loveman DM, Eldridge JA, et al. Modified Phalen's test as an aid in diagnosing carpal tunnel syndrome. Arthritis Care Res. 2012;64(2):287-289.
Bland JD. Carpal tunnel syndrome. BMJ. 2007;335(7615):343-346.
Basson A, Olivier B, Ellis R, et al. The Effectiveness of Neural Mobilization for Neuromusculoskeletal Conditions: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 2017;47(9):593-615.
Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev. 2007;(2):CD001554.
Wu YT, Ke MJ, Ho TY, et al. Randomized double-blinded clinical trial of 5% dextrose versus triamcinolone injection for carpal tunnel syndrome patients. Ann Neurol. 2018;84(4):601-610.
Baker NA, Moehling KK, Rubinstein EN, et al. The comparative effectiveness of combined lumbrical muscle splints and stretches on symptoms and function in carpal tunnel syndrome. Arch Phys Med Rehabil. 2012;93(1):1-10.
Rodríguez-Labrada R, Mederos-Rodríguez LE, Cedeño-Garcés AI, et al. Effectiveness of platelet-rich plasma as an adjuvant to surgical treatment of carpal tunnel syndrome. Arch Neurol. 2019;76(11):137-143.
Wang JC, Lao J, Chen S. Efficacy of modified hand exercises in treating carpal tunnel syndrome: A randomized controlled trial. Chin J Integr Med. 2017;23(2):82-91.
Gerritsen AA, de Vet HC, Scholten RJ, et al. Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomized controlled trial. JAMA. 2002;288(10):1245-1251.

Keywords: Carpal Tunnel Syndrome, Medical Management, Non-Surgical Treatment, Diagnostic Approaches, Risk Factors, Clinical Practice, Pharmacological Therapy, Patient Education, Physical Therapy, Corticosteroids, Clinical Trials.

manikath

Sunday, April 13, 2025