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Last year, the Journal of the Academy of Orthopaedic Surgeons reported that about 500,000 surgical procedures are performed each year to treat carpal tunnel syndrome. The same study reported the economic impact due to the condition is estimated to exceed $2 billion annually.

"Carpal tunnel syndrome, otherwise known as CTS, is among the most common disorders of the upper extremity," said Dr. Michael Keith, chair of the AAOS work group responsible for creating the guidelines. "It affects up to 10 percent of the population and is related to many factors, but is thought to be caused by increased pressure on the median nerve in the carpal tunnel in the wrist."

"The document serves as a point of reference and educational tool for both family practitioners and orthopedic surgeons, streamlining possible treatment processes for this ever so common ailment."

About the guidelines. The guidelines were developed by an AAOS physician volunteer work group and was based upon a systematic review of the current scientific and clinical information on accepted approaches to treatment or diagnosis of carpal tunnel syndrome. According to Keith, the entire process lasted about 18 months and included a review panel consisting of internal and external committees, public commentaries, and final approval by the AAOS board of directors.

The carpal tunnel treatment guidelines contain nine recommendations, which include operative and non-operative treatment options, as well as alternative techniques. Some of the recommendations include traditional bracing or splinting, local steroid injection, oral steroids, ultrasound, and carpal tunnel release surgery.

"This guideline is not intended to stand alone," Keith said. "It can be used as a starting point for physicians and can open up the lines of patient-physician communication on possible treatment options."

After a thorough analysis of the current literature, Keith said the work group found no evidence that supported treatments, including heat therapy, acupuncture, diuretics, electric stimulation, massage therapy, magnet therapy, and nutritional supplements.

As new research, knowledge and literature on carpal tunnel syndrome becomes available, Keith said the guidelines will be reviewed and reevaluated by the AAOS guidelines and technology oversight committee. The AAOS said it will consider updating the guidelines in three to five years, which Keith said will be consistent with evidence-based standards.

December 1, 2008

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