Clinical management of carpal tunnel syndrome: A 12-year review of outcomes

Carpal tunnel syndrome (CTS) is a disorder frequently encountered by occupa tional health care specialists. The health care management of this disorder has involved a diverse set of clinical procedures. The present article is a review of the literature related to CTS with an emphasis on occupational- related CTS. MEDLINE, Cumulative Index to Nursing and Allied Health Literat ure, PsycLIT: and NIOSHTIC databases from 1985-1997 were searched for treat ment outcome studies related to CTS Treatments of interest included surgery , physical therapy drug therapy: chiropractic treatment biobehavioral inter ventions and occupational rehabilitation. A systematic review of the effect s of these interventions on symptoms, medical status, function, return to w ork, psychological well-being and patient satisfaction was completed. Compa red to other treatments, the majority of studies assessed the effects of su rgical interventions. Endoscopic release was associated with higher levels of physical functioning and fewer days to return to work when compared to o pen release. Limited evidence indicated: 1) steroid injections and oral use of B6 were associated with pain reduction; 2) in comparison to splinting, range of motion exercises appeared to be associated with less pain and fewe r days to return to work; 3) cognitive behavior therapy yielded reductions in pain, anxiety, and depression; and, 4) multidisciplinary occupational re habilitation was associated with a higher percentage of chronic cases retur ning to work than usual care. Workers' compensation status was associated w ith increased time to return to work following surgery. Conclusions are pre liminary due to the small number of well-controlled studies, variability in duration of symptoms and disability, and the broad range of reported outco me measures. While there are several opinions regarding effective treatment , there is very little scientific support for the range of options currentl y used in practice. Despite the emerging evidence of the multivariate natur e of CTS, the majority of outcome studies have focused on single interventi ons directed at individual etiological factors or symptoms and functional l imitations secondary to CTS. (C) 1999 Wiley-Liss, Inc.