Diagnosis
Treatment
Activity modification. If possible, avoid activities that provoke symptom.
Splinting at night (Nocturnal wrist splinting). A brace that holds the wrist in the neutral position is the recommended initial therapy. This prevents waking up with numbness. Splinting for 8 weeks (e.g. a Cock-up wrist splint to wear when symptomatic).
Steroid injection. Inject methylprednisolone (40 mg)
Oral steroids. Prednisone 20 mg daily for 10 to 14 days if the patient declines a steroid injection. PO steroids should not exceed 4 weeks to minimize s/e.
Surgery – surgery for nerve decompression in patients with severe or chronic symptoms.
Physical therapy is not recommended, and full rest is unlikely in a person in a high-risk occupation for overuse syndromes.
Consider referral to an occupational therapist with subspecialty certification in hand therapy. It may improve outcomes
Reference / Further Reading
J Hand Surg Am. 2016 Jun;41(6):723-5. The Clinical Practice Guideline on Carpal Tunnel Syndrome and Workers’ Compensation. https://www.ncbi.nlm.nih.gov/pubmed/27113907
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Carpal-Tunnel-Syndrome-Fact-Sheet N Engl J Med 2002; 346:1807-1812. Carpal Tunnel Syndrome. http://www.nejm.org/doi/full/10.1056/NEJMcp013018