Differential Diagnosis, Severity Grading and Conservative Care

Ian asks three questions. First, whether it is carpal tunnel syndrome at all rather than cervical radiculopathy, thoracic outlet syndrome, compression at the pronator teres, compartment syndrome, Raynaud's or a wrist overuse injury. Second, whether it is mild (sensory symptoms, normal electrodiagnostics), moderate (some weakness, intermittent sleep disruption) or severe (significant weakness, altered electrodiagnostics, routine sleep disturbance). Third, for women, whether the patient is pregnant. Diabetes, fracture and older age worsen the prognosis. Mild to moderate cases, and severe cases in pregnancy, start with conservative care reviewed after 6 to 8 weeks, with electrodiagnostics if there is no change and surgery if axonal changes appear. Severe cases without pregnancy go to surgery. A meta-analysis found reduced median nerve mobility in carpal tunnel syndrome. Neurodynamic therapy with exercise reduced pain and improved function for up to a year, and adding shockwave improved results further, though long-term effects are unknown. Splinting shows little benefit before three months; night splinting and six months of use may help more.