Carpal tunnel syndrome: primary care and occupational factors

Abstract

Carpal tunnel syndrome (CTS) affects about 1% of working-aged people and is the commonest cause of hand pain in manual workers. CTS is a clinical diagnosis and does not warrant any further investigation in the presence of mild and suggestive CTS. Although the recommended non-surgical management is still a matter of debate, nocturnal splinting or steroid injection are recommended in most countries, with strong to moderate level of evidence for short-term efficacy. Patients with an uncertain diagnosis or severe symptoms, should undergo nerve conduction studies with referral to a hand specialist.

Keywords: carpal tunnel syndrome; clinical review; manual workers; pain; primary care.

Figure 1

Treatment algorithm.

Figure 2

Steroid injection. Using a sterile technique, methylprednisolone triamcinolone acetate (longer half-life) with 1 mL of 1% lidocaine is injected using a 25 gage, 1.5″ needle just proximal to the wrist crease, usually between the palmaris longus (gray line) and the flexor carpi ulnaris (black line), between 30° and 45° angle. Disproportionate pain, blood on aspiration or resistance requires immediate adjustment of the needle position (to avoid nerve damage or intravenous/intratendinous injection).