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Safer Care Victoria’s Best Care resources support patients and healthcare providers to have conversations and make decisions together about the most appropriate pathways for care.

This resource, developed for clinicians, details a specific elective surgery procedure that should now only be done for specific indications. Evidence-based recommendations that detail ‘best care’ pathways should be discussed with your patient to determine the most appropriate pathway of care. 

Advice

Managing patients diagnosed with carpal tunnel syndrome is based on the acuity and severity of clinical symptoms and the degree of neurogenic injury as assessed by electrodiagnostic studies.

Carpal tunnel release should not be performed in cases of mild carpal tunnel syndrome.

When is the procedure indicated?

Carpal tunnel release may be considered in cases of carpal tunnel syndrome where symptoms and presentation are more severe such as:

  • more constant symptoms (pain or sensory change)
  • muscle weakness
  • thenar muscle atrophy
  • electrodiagnostic findings of axon loss
  • failure to respond to conservative management.

Best care recommendations

Patients presenting with mild carpal tunnel syndrome should be offered conservative management, which may include:

  • hand therapy
  • splinting
  • local steroid injection
  • oral steroids.

Combined therapies may be more beneficial than therapies in isolation of one another. 

Evidence

Erickson M, Lawrence M, Stegink Jansen CW, Coker D, Amadio P, Cleary C. Hand pain and sensory deficits: carpal tunnel syndrome. Journal of Orthopaedic & Sports Physical Therapy [Internet]. 2019 May [cited 2020 Jun 23];49(5):CPG1-CPG85. 

Graham B, Peljovich AE, Afra R, Cho MS, Gray R, Stephenson J, et al. The American Academy of Orthopaedic Surgeons evidence-based clinical practice guideline on: management of carpal tunnel syndrome. Journal of Bone and Joint Surgery [Internet]. 2016 Oct [cited 2020 Jun 23];98(20):1750-4.

Hall B, Lee H, Fitzgerald H, Byrne B, Barton A, Lee A. Investigating the effectiveness of full-time wrist splinting and education in the treatment of carpal tunnel syndrome: a randomised controlled trial. American Journal of Occupational Therapy. 2013;67(4):448-59. 

Mooar PA, Doherty WJ, Murray JN, Pezold R, Sevarino KS. Management of carpal tunnel syndrome. The Journal of the American Academy of Orthopaedic Surgery [Internet]. 2018 Mar [cited 2020 Jun 23];26(6):e128-e130.

Queensland Health. Carpal tunnel release. Brisbane (QLD): The State of Queensland; 2011 [cited 2020 Jun 23].

Page last updated: 24 Dec 2020

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