The Hip: Preservation, Replacement and Revision

Non Operative Treatment of Carpal Tunnel Syndrome



- Discussion:
    - most useful in patients with an acute flare-up and in patients with minimal and intermittent symptoms;
    - avoiance of use of wrist, placement of wrist splint in a neutral position for day and night use, and NSAIDS;
          - only 20% of these pts will be free of symptoms at one year;
          - in the report by Westropp NM, et al, authors sought to determine whether standardized hand activity would produce changes in cross-sectional diameter of median nerve;
                  - ultrasound measures of proven reliability of the cross-sectional diameter of the median nerve in the wrist were taken;
                  - these measures were taken before activity and immediately after the activity, after 5 minutes, and after 10 minutes;
                  - median nerves of 40 normal subjects showed an increase in cross-sectional diameter immediately after hand activity then returned to a size close to the preactivity size within 10 minutes;
                  - cross-sectional area of the carpal canal did not change significantly after the hand activity was performed;
                  - female gender and body mass index over 25 were associated with significantly larger size increases in the median nerve;
                  - ref: The effect of a standard activity on the size of the median nerve as determined by ultrasound visualization
    - age of more than 50 years, duration of dz for > 10 months, & constant paresthesias are all poor indicators for non op treatment;
          - additionally, thenar atrophy and abnormal EMG Studies are negative indicators;
    - vit B6 (50 mg PO tid) may help some of patients;
    - reference:
         - Predictive factors in the non-surgical treatment of carpal tunnel syndrome.  
    - wrist splint:
         - references:
               - Position of the wrist associated with the lowest carpal-tunnel pressure: implications for splint design.
               - Carpal-tunnel syndrome. Results of a prospective trial of steroid injection and splinting.
               - Conservative management of carpal tunnel syndrome: a reexamination of steroid injection and splinting.
    - steroid injection:
         - night wrist extension splint used w/ small amount of cortisone instilled in carpal canal often gives long term relief;
         - 80% will have short term relief w/ steroid injection;
         - assess the patient's initial psychological reaction to the injection (excessive pain response may indicate excessive pain post op);
         - see technique of injection
               - if injection is done a No. 27 (5/8 in.) needle is used, & only 1 ml of plain lidocaine & 1 ml of cortisone solution is instilled (10 mg dexamethasone or 40mg triamcinolone)
               - avoid going directly into nerve, & if paresthesia's are elicited needle is withdrawn & placed in a more ulnar position;
         - references:
               - Intraneural steroid injection as a complication in the management of carpal tunnel syndrome. A report of three cases.
               - Carpal-tunnel syndrome. Results of a prospective trial of steroid injection and splinting.
               - A safe reliable method of carpal tunnel injection.
               - Conservative management of carpal tunnel syndrome: a reexamination of steroid injection and splinting.
               - Diagnostic and therapeutic value of carpal tunnel injection
               - Intracarpal steroid injection is safe and effective for short-term management of carpal tunnel syndrome.



The natural history of carpal tunnel syndrome. A study of 20 hands evaluated 4 to 9 years after initial diagnosis.

Clinical Course of the Non-Operated Hand in Patients With Bilateral Idiopathic Carpal Tunnel Syndrome




Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, December 21, 2012 12:31 pm