AAOS: New Guidelines for Treating Carpal Tunnel

Amanda Balbi

The American Academy of Orthopaedic Surgeons (AAOS) has released new clinical guidelines on diagnosing and treating carpal tunnel syndrome. The guidelines aim to improve treatment and patient care based on the current best evidence.

The committee that worked on the guideline performed a systematic review of published studies from February 2013 to February 2015 that focused on diagnosing and treating carpal tunnel syndrome.
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As a result of their research, the AAOS made various recommendations, including:

  • Diagnostic scales, such as questionnaires and electrodiagnostic studies.
  • Immobilization braces, splints, and orthosis.
  • Methylprednisolone steroid injections and oral steroids.
  • Ketoprofen phonophoresis over placebo.
  • Surgical release of the traverse carpal ligament.
  • Endoscopic carpal tunnel release.

In addition, the AAOS recommends against diagnosing carpal tunnel by using:

  • Thenar atrophy as an observational sign of carpal tunnel.
  • Physical signs such as the Phalen Test, Tinel Sign, or Flick Sign.
  • Maneuvers such as the carpal compression test or manual muscle testing.
  • History interview topics including worsening symptoms at night, duration of symptoms, and patient localization of symptoms.
  • Patient-reported numbness or pain.
  • MRIs or ultrasounds.

“Treatment decisions should be made in light of all circumstances presented by the patient,” the committee concluded. “Treatments and procedures applicable to the individual patient rely on mutual communication between patient, physician, and other healthcare practitioners.”

—Amanda Balbi

Reference:

American Academy of Orthopaedic Surgeons. Management of carpal tunnel syndrome evidence-based clinical practice guideline. Published February 29, 2016. www.aaos.org/ctsguideline.