Speciality Medical Dialogues
    • facebook
    • twitter
    Login Register
    • facebook
    • twitter
    Login Register
    • Medical Dialogues
    • Education Dialogues
    • Business Dialogues
    • Medical Jobs
    • Medical Matrimony
    • MD Brand Connect
    Speciality Medical Dialogues
    • Editorial
    • News
        • Anesthesiology
        • Cancer
        • Cardiac Sciences
        • Critical Care
        • Dentistry
        • Dermatology
        • Diabetes and Endo
        • Diagnostics
        • ENT
        • Featured Research
        • Gastroenterology
        • Geriatrics
        • Medicine
        • Nephrology
        • Neurosciences
        • Nursing
        • Obs and Gynae
        • Ophthalmology
        • Orthopaedics
        • Paediatrics
        • Parmedics
        • Pharmacy
        • Psychiatry
        • Pulmonology
        • Radiology
        • Surgery
        • Urology
    • Practice Guidelines
        • Anesthesiology Guidelines
        • Cancer Guidelines
        • Cardiac Sciences Guidelines
        • Critical Care Guidelines
        • Dentistry Guidelines
        • Dermatology Guidelines
        • Diabetes and Endo Guidelines
        • Diagnostics Guidelines
        • ENT Guidelines
        • Featured Practice Guidelines
        • Gastroenterology Guidelines
        • Geriatrics Guidelines
        • Medicine Guidelines
        • Nephrology Guidelines
        • Neurosciences Guidelines
        • Obs and Gynae Guidelines
        • Ophthalmology Guidelines
        • Orthopaedics Guidelines
        • Paediatrics Guidelines
        • Psychiatry Guidelines
        • Pulmonology Guidelines
        • Radiology Guidelines
        • Surgery Guidelines
        • Urology Guidelines
    LoginRegister
    Speciality Medical Dialogues
    LoginRegister
    • Home
    • Editorial
    • News
      • Anesthesiology
      • Cancer
      • Cardiac Sciences
      • Critical Care
      • Dentistry
      • Dermatology
      • Diabetes and Endo
      • Diagnostics
      • ENT
      • Featured Research
      • Gastroenterology
      • Geriatrics
      • Medicine
      • Nephrology
      • Neurosciences
      • Nursing
      • Obs and Gynae
      • Ophthalmology
      • Orthopaedics
      • Paediatrics
      • Parmedics
      • Pharmacy
      • Psychiatry
      • Pulmonology
      • Radiology
      • Surgery
      • Urology
    • Practice Guidelines
      • Anesthesiology Guidelines
      • Cancer Guidelines
      • Cardiac Sciences Guidelines
      • Critical Care Guidelines
      • Dentistry Guidelines
      • Dermatology Guidelines
      • Diabetes and Endo Guidelines
      • Diagnostics Guidelines
      • ENT Guidelines
      • Featured Practice Guidelines
      • Gastroenterology Guidelines
      • Geriatrics Guidelines
      • Medicine Guidelines
      • Nephrology Guidelines
      • Neurosciences Guidelines
      • Obs and Gynae Guidelines
      • Ophthalmology Guidelines
      • Orthopaedics Guidelines
      • Paediatrics Guidelines
      • Psychiatry Guidelines
      • Pulmonology Guidelines
      • Radiology Guidelines
      • Surgery Guidelines
      • Urology Guidelines
    • Home
    • Practice Guidelines
    • Featured Practice Guidelines
    • Management of carpal...

    Management of carpal tunnel syndrome : American Academy of Orthopaedic Surgeons guidelines

    Written by supriya kashyap kashyap Published On 2016-07-27T15:22:26+05:30  |  Updated On 27 July 2016 3:22 PM IST
    Management of carpal tunnel syndrome : American Academy of Orthopaedic Surgeons guidelines

    Carpal Tunnel Syndrome is a symptomatic compression neuropathy of the median nerve at the level of the wrist, characterized physiologically by evidence of increased pressure within the carpal tunnel and decreased function of the nerve at that level. Carpal Tunnel Syndrome can be caused by many different diseases, conditions and events. It is characterized by patients as producing numbness, tingling, hand and arm pain and muscle dysfunction. The disorder is not restricted by age, gender, ethnicity, or occupation and is associated with or caused by systemic disease and local mechanical and disease factors.


    In 2016, American Academy of Orthopedic Surgeons came out with the guidelines on Management of Carpel Tunnel Syndrome- Evidence based clinical practice guidelines


    Following are its major recommendations:-


    Observation


    Strong evidence supports thenar atrophy is strongly associated with ruling-in carpal tunnel syndrome (CTS), but poorly associated with ruling-out CTS.


    Physical Signs


    Strong evidence supports not using the Phalen test, Tinel sign, Flick sign, or Upper limb neurodynamic/nerve tension test (ULNT) criterion A/B as independent physical examination maneuvers to diagnose carpal tunnel syndrome, because alone, each has a poor or weak association with ruling-in or ruling-out CTS.


    Maneuvers


    Moderate evidence supports not using the following as independent physical examination maneuvers to diagnose CTS, because alone, each has a poor or weak association with ruling-in or ruling-out CTS:




    • Carpal compression test

    • Reverse Phalen test

    • Thenar weakness or thumb abduction weakness or abductor pollicis brevis manual muscle testing

    • 2-point discrimination

    • Semmes-Weinstein monofilament test

    • CTS-relief maneuver (CTS-RM)

    • Pin prick sensory deficit; thumb or index or middle finger

    • ULNT Criterion C

    • Tethered median nerve stress test

    • Vibration perception- tuning fork

    • Scratch collapse test

    • Luthy sign

    • Pinwheel


    History Interview Topics


    Moderate evidence supports not using the following as independent history interview topics to diagnose CTS, because alone, each has a poor or weak association with ruling-in or ruling-out CTS:

    • Sex/gender

    • Ethnicity

    • Bilateral symptoms

    • Diabetes mellitus

    • Worsening symptoms at night

    • Duration of symptoms

    • Patient localization of symptoms

    • Hand dominance

    • Symptomatic limb

    • Age

    • Body mass index ()


    Patient Reported Numbness or Pain


    Limited evidence supports that patients who do not report frequent numbness or pain might not have CTS.


    Hand-held Nerve Conduction Study (NCS)


    Limited evidence supports that a hand-held NCS device might be used for the diagnosis of CTS.


    Magnetic Resonance Imaging (MRI)


    Moderate evidence supports not routinely using MRI for the diagnosis of CTS.


    Diagnostic Ultrasound


    Limited evidence supports not routinely using ultrasound for the diagnosis of CTS.


    Diagnostic Scales


    Moderate evidence supports that diagnostic questionnaires and/or electrodiagnostic studies could be used to aid the diagnosis of CTS.


    Increased Risk of CTS




    1. Strong evidence supports that BMI and high hand/wrist repetition rate are associated with the increased risk of developing CTS.



      • Peri-menopausal

      • Wrist ratio/index

      • Rheumatoid arthritis

      • Psychosocial factors

      • Distal upper extremity tendinopathies

      • Gardening

      • American Conference of Governmental Industrial Hygienists Hand Activity Level at or above threshold

      • Assembly line work

      • Computer work

      • Vibration

      • Tendinitis

      • Workplace forceful grip/exertionModerate evidence supports that the following factors are associated with the increased risk of developing CTS:

      • Dialysis

      • Fibromyalgia





      • Varicosis

      • Distal radius fractureLimited evidence supports that the following factors are associated with the increased risk of developing CTS:




    Decreased Risk of CTS


    Moderate evidence supports that physical activity/exercise is associated with the decreased risk of developing CTS.


    Factors Showing No Associated Risk of CTS




    1. Moderate evidence supports that the use of oral contraception and female hormone replacement therapy (HRT) are not associated with increased or decreased risk of developing CTS.

    2. Limited evidence supports that race/ethnicity and female education level are not associated with increased or decreased risk of developing CTS.


    Factors Showing Conflicting Risk of CTS


    Limited evidence supports that the following factors have conflicting results regarding the development of CTS:




    • Diabetes

    • Age

    • Gender/sex

    • Genetics

    • Comorbid drug use

    • Smoking

    • Wrist bending

    • Workplace


    Immobilization


    Strong evidence supports that the use of immobilization (brace/splint/orthosis) should improve patient reported outcomes.


    Steroid Injections


    Strong evidence supports that the use of steroid (methylprednisolone) injection should improve patient reported outcomes.


    Magnet Therapy


    Strong evidence supports not using magnet therapy for the treatment of CTS.


    Oral Treatments


    Moderate evidence supports no benefit of oral treatments (diuretic, gabapentin, astaxanthin capsules, non-steroidal anti-inflammatory drugs [NSAIDs], or pyridoxine) compared to placebo.


    Oral Steroids


    Moderate evidence supports that oral steroids could improve patient reported outcomes as compared to placebo.


    Ketoprofen Phonophoresis


    Moderate evidence supports that ketoprofen phonophoresis could provide reduction in pain compared to placebo.


    Therapeutic Ultrasound


    Limited evidence supports that therapeutic ultrasound might be effective compared to placebo.


    Laser Therapy


    Limited evidence supports that laser therapy might be effective compared to placebo.


    Surgical Release Location


    Strong evidence supports that surgical release of the transverse carpal ligament should relieve symptoms and improve function.


    Surgical Release Procedure


    Limited evidence supports that if surgery is chosen, a practitioner might consider using endoscopic carpal tunnel release based on possible short term benefits.


    Surgical Versus Nonoperative


    Strong evidence supports that surgical treatment of carpal tunnel syndrome should have a greater treatment benefit at 6 and 12 months as compared to splinting, NSAIDs/therapy, and a single steroid injection.


    Adjunctive Techniques


    Moderate evidence supports that there is no benefit to routine inclusion of the following adjunctive techniques: epineurotomy, neurolysis, flexor tenosynovectomy, and lengthening/reconstruction of the flexor retinaculum (transverse carpal ligament).


    Bilateral Versus Staged Carpal Tunnel Release


    Limited evidence supports that simultaneous bilateral or staged endoscopic carpal tunnel release might be performed based on patient and surgeon preference. No evidence meeting the inclusion criteria was found addressing bilateral simultaneous open carpal tunnel release.


    Local Versus Intravenous (IV) Regional Anesthesia


    Limited evidence supports the use of local anesthesia rather than IV regional anesthesia (bier block) because it might offer longer pain relief after carpal tunnel release; no evidence meeting the inclusion criteria was found comparing general anesthesia to either regional or local anesthesia for carpal tunnel surgery.


    Buffered Versus Plain Lidocaine


    Moderate evidence supports the use of buffered lidocaine rather than plain lidocaine for local anesthesia because it could result in less injection pain.


    Aspirin Use


    Limited evidence supports that the patient might continue the use of aspirin perioperatively; no evidence meeting the inclusion criteria addressed other anticoagulants.


    Preoperative Antibiotics


    Limited evidence supports that there is no benefit for routine use of prophylactic antibiotics prior to carpal tunnel release because there is no demonstrated reduction in postoperative surgical site infection.


    Supervised Versus Home Therapy


    Moderate evidence supports no additional benefit to routine supervised therapy over home programs in the immediate postoperative period. No evidence meeting the inclusion criteria was found comparing the potential benefit of exercise versus no exercise after surgery.


    Postoperative Immobilization


    Strong evidence supports no benefit to routine postoperative immobilization after carpal tunnel release.


    For detailed guidelines click on the following link:


    http://www.aaos.org/uploadedFiles/PreProduction/Quality/Guidelines_and_Reviews/guidelines/CTS CPG_6 7 2016.pdf
    Carpal compression testcarpal tunnel syndromeCTSDiabetes Mellitushormone replacement therapyHRTmagnetic resonance imagingMRINCSNerve Conduction StudyNSAIDULNTUpper limb neurodynamic/nerve tension test
    Source : American Academy of Orthopedic Surgeons

    Disclaimer: This site is primarily intended for healthcare professionals. Any content/information on this website does not replace the advice of medical and/or health professionals and should not be construed as medical/diagnostic advice/endorsement or prescription. Use of this site is subject to our terms of use, privacy policy, advertisement policy. © 2020 Minerva Medical Treatment Pvt Ltd

    supriya kashyap kashyap
    supriya kashyap kashyap
      Show Full Article
      Next Story
      Similar Posts
      NO DATA FOUND

      • Email: info@medicaldialogues.in
      • Phone: 011 - 4372 0751

      Website Last Updated On : 12 Oct 2022 7:06 AM GMT
      Company
      • About Us
      • Contact Us
      • Our Team
      • Reach our Editor
      • Feedback
      • Submit Article
      Ads & Legal
      • Advertise
      • Advertise Policy
      • Terms and Conditions
      • Privacy Policy
      • Editorial Policy
      • Comments Policy
      • Disclamier
      Medical Dialogues is health news portal designed to update medical and healthcare professionals but does not limit/block other interested parties from accessing our general health content. The health content on Medical Dialogues and its subdomains is created and/or edited by our expert team, that includes doctors, healthcare researchers and scientific writers, who review all medical information to keep them in line with the latest evidence-based medical information and accepted health guidelines by established medical organisations of the world.

      Any content/information on this website does not replace the advice of medical and/or health professionals and should not be construed as medical/diagnostic advice/endorsement or prescription.Use of this site is subject to our terms of use, privacy policy, advertisement policy. You can check out disclaimers here. © 2025 Minerva Medical Treatment Pvt Ltd

      © 2025 - Medical Dialogues. All Rights Reserved.
      Powered By: Hocalwire
      X
      We use cookies for analytics, advertising and to improve our site. You agree to our use of cookies by continuing to use our site. To know more, see our Cookie Policy and Cookie Settings.Ok