Carpal Tunnel Syndrome

Diagnostic accuracy of neurodynamic tests in upper-limb entrapment neuropathies: A systematic review and meta-analysis.

Albert-Lucena D, Navarro-Santana MJ, Díaz-Arribas MJ, Rabanal-Rodríguez G, Valera-Calero JA, Fernández-de-Las-Peñas C · Musculoskeletal science & practice · 2025

Upper-limb neurodynamic tests are commonly used to diagnose neuropathies in this area, including cervical radiculopathy and carpal tunnel syndrome, although their diagnostic accuracy remains uncertain across different conditions and criteria. To assess the diagnostic accuracy of upper-limb neurodynamic tests and their variations and criteria for upper-limb entrapment neuropathies. A systematic review with meta-analysis was conducted in different databases (for their inception in February 2025), including studies evaluating the diagnostic accuracy of these tests. Sensitivity, specificity, likelihood ratios (LR), diagnostic odds ratios, diagnostic accuracy and the area under the curve (AUC) were calculated using a bivariate and univariate meta-analysis. The quality of evidence was evaluated using the GRADE approach, and meta-regression was performed to examine the influence of diagnostic criteria. Twelve studies were included. Likelihood ratios for neuropathic pain conditions were LR+

Ultrasound-Guided Nerve Hydrodissection for the Management of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis.

Lee K, Park JM, Yoon SY, Kim MS, Kim YW, Shin JI · Yonsei medical journal · 2025 · n=458

Ultrasound-guided nerve hydrodissection has emerged as a potential non-surgical treatment for carpal tunnel syndrome (CTS). The objective of this research was to offer suggestions for optimizing injectables utilized in hydrodissection for the treatment of CTS through a systematic review and network meta-analysis. PubMed, MEDLINE, EMBASE, Cochrane, Scopus, and Web of Science were searched through April 25, 2024. Effect sizes were quantified using standard mean differences within a random-effects model. Effectiveness ranking for each treatment was expressed as the surface under the cumulative ranking curve (SUCRA). Nine studies with 458 patients with CTS were included. According to SUCRA, 5% dextrose (DW) was the most effective option for the Boston Carpal Tunnel Questionnaire (BCTQ) function at 99.9, 89.8, and 88.8 at 4, 12, and 24 weeks, respectively; for BCTQ symptoms, 5% DW was the most effective option at 99.9 at 4 weeks and platelet-rich plasma at 95.7 and 93.9 at 12 and 24 weeks

A systematic review and meta-analysis of the effectiveness of high-intensity laser therapy in patients with carpal tunnel syndrome.

de la Barra Ortiz HA, Avila MA, Parizotto NA, Liebano RE · Physiotherapy · 2025

This systematic review aimed to evaluate the effects of high-intensity laser therapy (HILT) on pain intensity, disability, and electrophysiological parameters in individuals diagnosed with carpal tunnel syndrome (CTS). A search of electronic databases, including PubMed, Web of Science, Scopus, CINAHL, Science Direct, Cochrane Library, the PEDro database, and Google Scholar (updated until February 18, 2025), was conducted for randomized controlled trials (RCTs). Data were extracted independently by three researchers. The quality of RCTs was assessed using the Cochrane Risk of Bias (RoB) 2.0 tool, while evidence certainty was evaluated with the GRADE approach. Primary outcomes included pain intensity, with secondary outcomes comprising electrophysiological parameters and disability. Nine RCTs met inclusion criteria. Most studies exhibited a low risk of bias across RoB2 domains, except for outcome measurement, resulting in an overall RoB of 44%. Meta-analyses demonstrated that HILT, al

Comparison of Diagnostic Modalities for Carpal Tunnel Syndrome: A Systematic Review.

Gay ME, Lima JG, Vieites V, Belnap SC, Morgan R · Cureus · 2025

Carpal tunnel syndrome (CTS) is a common nerve entrapment disorder that affects millions, particularly older adults and women. It causes numbness, tingling, and discomfort in the hand, primarily affecting the median nerve. Risk factors include occupation (e.g., jobs involving repetitive motion or vibrating tools) and conditions such as obesity, pregnancy, and diabetes. Accurate diagnosis is critical for effective treatment, with nerve conduction studies (NCS) and ultrasound (US) being two key diagnostic methods. Each approach has strengths, limitations, and diagnostic utility, necessitating a comparison to determine the best use case for each tool. This comprehensive systematic review aims to compare the diagnostic accuracy and clinical utility of NCS and US in diagnosing CTS and provide conclusions on the most appropriate modality in different clinical scenarios.  A PubMed literature review conducted in August 2024 identified 49 studies. Of these, 31 were excluded for design and

L-Carnitine in the Treatment of Psychiatric and Neurological Manifestations: A Systematic Review.

Wang W, Pan D, Liu Q, Chen X, Wang S · Nutrients · 2024

L-carnitine (LC), a vital nutritional supplement, plays a crucial role in myocardial health and exhibits significant cardioprotective effects. LC, being the principal constituent of clinical-grade supplements, finds extensive application in the recovery and treatment of diverse cardiovascular and cerebrovascular disorders. However, controversies persist regarding the utilization of LC in nervous system diseases, with varying effects observed across numerous mental and neurological disorders. This article primarily aims to gather and analyze database information to comprehensively summarize the therapeutic potential of LC in patients suffering from nervous system diseases while providing valuable references for further research. A comprehensive search was conducted in PubMed, Web Of Science, Embase, Ovid Medline, Cochrane Library and Clinicaltrials.gov databases. The literature pertaining to the impact of LC supplementation on neurological or psychiatric disorders in patients was revie

Aromatase Inhibitor-Induced Carpal Tunnel Syndrome and Stenosing Tenosynovitis: A Systematic Review.

Chung KY, Ho G, Novak CB, Baltzer HL · Plastic and reconstructive surgery · 2022

Although aromatase inhibitors are the first-line treatment in postmenopausal women with hormone receptor-positive breast cancer, there is increasing evidence that they can induce carpal tunnel syndrome and stenosing tenosynovitis. This systematic review summarizes the risk factors, incidence, and management for patients with aromatase inhibitor-induced carpal tunnel syndrome and stenosing tenosynovitis compared to tamoxifen or placebo. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided systematic review of PubMed/MEDLINE, Ovid Embase, and the Cochrane Central Register of Controlled Trials was conducted (to March 19, 2020), supplemented with Google Scholar, Plastic and Reconstructive Surgery, and The Journal of Hand Surgery. Two reviewers independently completed the primary and secondary screens and the quality appraisal. This study reviewed 577 abstracts and included 19 studies. Risk factors for aromatase inhibitor-induced carpal tunnel syndrome or stenosing

Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome: Revision 2026.

Erickson M, Lawrence M, Lazinski MJ, Scott K, Martin RL · The Journal of orthopaedic and sports physical therapy · 2026

APTA Orthopedics and APTA Hand and Upper Extremity Physical Therapy, Academies of the American Physical Therapy Association, have an ongoing effort to create evidence-based clinical practice guidelines (CPGs) for physical therapy management and prevention of upper extremity musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability and Health (ICF). This particular guideline is a revision of the 2019 CPG that focuses on hand pain and sensory deficits in carpal tunnel syndrome. J Orthop Sports Phys Ther 2026;56(4):CPG1-CPG79. Epub 12 February 2026. doi:10.2519/jospt.2026.0301.

Transthyretin Cardiac Amyloidosis Evaluation and Management: 2025 ACC Concise Clinical Guidance.

Writing Committee, Kittleson MM, Ambardekar AV, Cheng RK, Griffin JM, Maurer MS · Journal of the American College of Cardiology · 2026

Transthyretin amyloid cardiomyopathy has emerged as an increasingly recognized cause of heart failure, particularly in older individuals. There is now greater awareness of transthyretin amyloid cardiomyopathy as an underlying etiology of heart failure, particularly in individuals with musculoskeletal manifestations such as bilateral carpal tunnel syndrome or spinal stenosis. There have also been substantial advances in diagnosis, including the ability to perform accurate noninvasive diagnosis using radionuclide scintigraphy in individuals with a negative monoclonal protein screen. Finally, individuals with transthyretin amyloid cardiomyopathy have benefitted from advances in broadly effective heart failure therapies, namely mineralocorticoid receptor antagonists and sodium glucose-cotransporter 2 inhibitors, as well as specific disease-modifying therapies with transthyretin stabilizers, tafamidis and acoramidis, and the transthyretin silencer vutrisiran. The purpose of this Concise Cli

[Expert Consensus Recommendations for the Diagnosis of Hereditary Transthyretin Amyloidosis with Polyneuropathy (hATTR-PN) in Chile].

Bevilacqua JA, Matamala JM, Zamorano I, Hernández Ú, Acosta I, Jurado F · Revista medica de Chile · 2026

Hereditary transthyretin amyloidosis is an autosomal dominant disease caused by mutations in the TTR gene, which encodes the protein transthyretin. It is characterized by the deposit of mutated transthyretin in multiple organs and systems, mainly the heart and peripheral nervous system, causing different forms of polyneuropathy. It is a progressive, disabling and fatal disease. Early diagnosis of hereditary amyloidosis, including amyloidotic neuropathy, is currently relevant, as there are specific treatments that modify the natural course of the disease. The purpose of this consensus is to provide recommendations for Chile, based on scientific evidence, which facilitate the suspicion and early diagnosis of familial amyloidosis, focused on those patients who present with neuropathy as the initial manifestation, to facilitate the timely treatment of affected patients. A recommendation was developed by consensus through the Delphi method by eight Chilean neurologists specialized in neurom

Effects of electroacupuncture on carpal tunnel syndrome: a clinical, electrophysiological and ultrasonographical pilot study.

Ntoutsouli AM, Georgoudis G, Papapostolou A, Karavis M, Petrou DD, Vadalouca A · Acupuncture in medicine : journal of the British Medical Acupuncture Society · 2025 · n=12

Carpal tunnel syndrome (CTS) is the most common compressive neuropathy and is associated with significant strain on both patients and healthcare systems. Acupuncture is one of the conservative treatments used for this syndrome, although more evidence is needed regarding the efficacy of this intervention. The aim of this pilot study was to evaluate the effects of electroacupuncture (EA) in patients with CTS through clinical, electrophysiological and ultrasonographical assessments. Seventeen wrists, belonging to a total of 12 patients who had been diagnosed with CTS, were included. Eight EA sessions were performed (twice a week for 4 weeks). The visual analogue scale (VAS), symptom severity scale (SSS) and functional status scale (FSS) of the Boston Carpal Tunnel Questionnaire (BCTQ) were administered, median nerve conduction studies were performed and the cross-sectional area (CSA) of the median nerve was measured by ultrasound. These evaluations were made at baseline and 3-7&#x

The effects of virtual reality-mediated tendon and nerve gliding exercises in the conservative management of carpal tunnel syndrome: a double-blind randomized placebo controlled trial.

Arman S, Menekseoglu AK, Sezgin B, Ozgur B, Capan N, Oral A · European journal of physical and rehabilitation medicine · 2024 · n=33

Carpal tunnel syndrome (CTS) is a common condition resulting from compression of the median nerve at the wrist. First-line treatment typically involves conservative management, which commonly includes splinting and gliding exercises. Emerging evidence suggests the potential benefits of using virtual reality (VR) in rehabilitation. This study aimed to assess the effects of VR-mediated tendon and nerve gliding exercises on the conservative treatment of CTS, compared to video-assisted (sham virtual) and home-based gliding exercises. This study was a prospective, double-blind, randomized, placebo controlled interventional trial. The study was conducted in the Department of Physical Medicine and Rehabilitation at a university hospital. The study included patients with mild to moderate CTS. The study included a total of 54 hands from 33 patients. The participants were randomly allocated into three groups: the VR-mediated group (VG), the sham VR-mediated group (SG), and the control (home

Volume Effect of Nerve Hydrodissection for Carpal Tunnel Syndrome: A Prospective, Randomized, and Single-Blind Study.

Huang CY, Lai CY, Reeves KD, Lam KHS, Li TY, Cheng CI · Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine · 2024

This study compared ultrasound-guided nerve hydrodissection (HD) outcomes using two commonly used injectate volumes (10 and 5 mL) of normal saline to explore if there is a volume effect of HD for patients with moderate carpal tunnel syndrome (CTS). Twenty-four participants were randomly assigned to treatment with HD using ultrasound-guidance and either 10 mL or 5 mL of normal saline (HD-10 and HD-5 groups respectively). Our primary outcome measures were the change scores of the two subscales of the Boston Carpal Tunnel Syndrome Questionnaire: The Symptom Severity Scale (SSS) and Functional Status Scale (FSS). We conducted a one-way repeated analysis of variance for 3 time points (4, 12, and 24 weeks) for both SSS and FSS, respectively, for change scores from time 0, and percentage change from time 0. All participants (n = 12 per group) completed the study. From 0 to 24 weeks the HD-10 group outperformed the HD-5 group for improvement i

Acromegaly diagnosis.

Yogi-Morren D, Chanson P · The Journal of clinical endocrinology and metabolism · 2026

The clinical presentation of acromegaly reflects systemic effects of chronic growth hormone (GH) and insulin-like growth factor 1 (IGF-I) excess. Diagnostic delay frequently ranges from 6 to 10 years. While classical manifestations such as acral enlargement and facial coarsening are diagnostically important, many patients initially develop nonspecific symptoms, including sleep apnea, carpal tunnel syndrome, arthralgia, and metabolic disturbances. The lack of symptom/comorbidity specificity highlights the need for improved screening strategies, particularly for patients without overt acral changes. Comorbidity cluster analyses, potentially supported by artificial intelligence, may facilitate earlier identification, prompting biochemical confirmation of the diagnosis. Biochemical evaluation has benefited from advances in hormone assay harmonization and the establishment of robust age-adjusted reference ranges. Serum IGF-I is the preferred initial screening test due to its stability and r

Understanding degenerative cervical myelopathy in musculoskeletal practice.

Cervellini M, Feller D, Maselli F, Rossettini G, Cook C, Tabrah J · The Journal of manual & manipulative therapy · 2025

Degenerative cervical myelopathy (DCM) is a clinical syndrome characterized by a progressive compression of the spinal cord. DCM often looks like common symptoms of aging or bilateral carpal tunnel syndrome in its early stages, requiring careful differential diagnosis. Identifying DCM is a real challenge as no validated screening tools are available for making the DCM diagnosis. Potentially, individuals with DCM may experience misdiagnosis or substantial diagnostic delays, with an enhanced risk of irreversible neurological consequences if not promptly addressed. Despite the increasing prevalence, there is a lack of awareness about DCM among both the public and healthcare professionals. However, patients may seek physiotherapy to obtain a diagnosis or access treatment. A comprehensive (non-systematic) review of the literature about DCM epidemiology, pathophysiology, clinical presentation, diagnostic methods, and management was conducted. A guide and essential knowledge to facilitate c

Unraveling the causality between carpal tunnel syndrome and trigger finger through genetic instrumental variables.

Huang J, Deng K, Huang S, Lv Z, Zhou S, Chen M · European journal of medical research · 2025

Carpal tunnel syndrome (CTS) and trigger finger (TF) are the two most common non-traumatic connective tissue disorders of the hands. These conditions often manifest concurrently in certain patients; however, the mechanisms underlying this phenotypic association remain inadequately understood. In this study, we aimed to systematically investigate the causal relationship between CTS and TF using a large sample size and advanced methods. In this study, comprehensive summary-level data on CTS and TF from genome-wide association studies (GWAS) were collected. The causal relationship between CTS and TF was investigated using two-sample Mendelian randomization (MR). Sensitivity analyses were conducted to evaluate the robustness of MR findings. Furthermore, multivariable Mendelian randomization (MVMR) was employed to examine the role of CTS in causation and adjust for potential confounding variables. Additionally, supplementary reverse MR analysis was performed to ascertain the causal effect

Carpal Tunnel Syndrome (search results)

NCCIH

The National Center for Complementary and Integrative Health provides information and research on complementary health approaches for various conditions, including search results relevant to carpal tunnel syndrome. It offers evidence-based insights into alternative therapies.

A Randomised Controlled Double Blind Trial Of Therapeutic Ultrasound in Carpal Tunnel Syndrome (CTS)

n=40 · NCT01590745 · COMPLETED · COMPLETED

Carpal Tunnel Syndrome (CTS) is a recognisable pattern of symptoms and signs, which are caused by compression of the median (middle) nerve as it passes through the carpal tunnel at the wrist. This condition affects individuals by causing pain, numbness, tingling sensations and sometimes weakness in the fingers and may extend to shoulder and neck areas. The cause for most cases is unknown (idiopathic) though some common conditions are associated with an increased incidence, including obesity, pregnancy, hypothyroidism, arthritis, diabetes, and trauma. Diagnosis is primarily clinical and the condition is easily recognised from the characteristic symptoms in straightforward cases but diagnostic support is provided by investigations such as nerve conduction studies and ultrasound imaging. Treatment may include splinting, local steroid injection at wrist, activity modification,physical or occupational therapy (controversial), medications, and surgery. Treatment with local therapeutic ultrasound has been suggested to be effective but existing trials are inconclusive. Wrist splinting is only partially effective with a success rate of 34%, Steroid injection is followed by frequent relapses and there remains uncertainty about the safety of serial injections. Surgery is effective but has a small but significant incidence of permanent complications. Any demonstrably effective and safe addition to the therapeutic options would be a significant advance in treatment. Therapeutic ultrasound at present appears a promising option, having a very good safety record but so far uncertain evidence of efficacy. In our trial patients, with mild carpal tunnel syndrome, confirmed by nerve conduction studies, will all be given wrist splints so that no patients will be left untreated. They will be randomly allocated to either therapeutic or sham ultrasound therapy (20 sessions over 7 weeks) and followed up for 1year. The patients, operators of the ultrasound equipment and assessors will all be blind to treatment allocation. The effect of treatment on symptoms will be assessed using a validated questionnaire and nerve conduction studies will be repeated at completion of the ultrasound treatment, 6 and 12 months. This study is designed to find out to whether therapeutic ultrasound is an effective treatment for carpal tunnel syndrome (CTS).

WALANT Technique (Wide Awake Local Anesthesia No Tourniquet) in Association With Analgesic Troncular Blocks at the Wirst for Carpal Tunnel Release.

n=60 · NCT04494100 · COMPLETED · COMPLETED

The carpal tunnel release (CTR) is now performed almost exclusively under regional anesthesia (RA) in France. RA requires the use of a pneumatic tourniquet to limit blood flow to the operated extremity and create a bloodless surgical field for a clear visualization of the anatomic structures by the surgeon. Multiple approaches to block the brachial plexus can be considered. The most common technique is the axillary block (BAX) that provides complete anesthesia for the patient's arm and forearm. This technique offers anesthesia not only for the surgical area but also for the root of the arm where the pneumatic tourniquet is placed. However this technique have limits: the persistence of a motor block in the arm and the forearm that is not compatible with a quick hospital discharge (short term ambulatory hospitalization) and the need for assistance with dressing and eating after surgery. More distal anesthetic techniques are proposed such as the troncular blocks (TRONC) that avoid motor block of the arm and offer an earlier recovery and autonomy for the patient. However, they lead to a poor tolerance to the tourniquet due to its application on a non-anesthetized area.The pain related to the pressure of the tourniquet can occur within the first few minutes of its inflation, get worse over time and persist for several minutes after its deflation. Therefore, TRONC procedure is less often performed compared to the BAX for major surgeries but it remains appropriate for CTR. The Wide Awake Local Anesthesia No Tourniquet (WALANT) technique is widely used in Canada and has been proposed for hand and wirst minor surgeries. WALANT uses a combination of a local anesthetic (LA) and epinephrine to induce anesthesia and hemostasis in the area of the surgical procedure in order to allow surgeries to be done without the use of tourniquet. Epinephrine is a vasoconstrictor agent that reduces blood flow at surgical site. This bloodless effect is visualized on the skin by a pale color. Thus, WALANT can provide a chemical tourniquet and eliminate the pain from a traditional arm tourniquet. However, this technique is performed with a short-acting LA and does not offer any postoperative analgesia. The association of TRONC using long-acting LA with the WALANT technique could combine the comfort of a surgery without tourniquet to a long-acting analgesia and thus could provide a superior overall comfort. The main objective of this prospective, multicentre, randomized, open-label, parallel-group controlled trial is to evaluate the interest of WALANT technique on patient comfort during CTR performed with TRONC, compared to the tourniquet.

Evaluation of Fascial Manipulation for the Conservative Treatment of Carpal Tunnel Syndrome: Double Blind Randomized Clinical Trial, Phase II

n=14 · NCT02495298 · COMPLETED · COMPLETED

The trial aims to evaluate the effectiveness of Fascial Manipulation on pain reduction, functional recovery and nerve conduction of patients with Carpal Tunnel Syndrome (CTS). Visual Analogue Scale (VAS), Disabilities of the Arm, Shoulder and Hand scale (DASH), Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and Electroneuromyography were assessed. The study is blind for the patient and the raters.

TRIP Database: Carpal Tunnel Syndrome

TRIP Database

TRIP Database offers a federated search across multiple evidence sources for carpal tunnel syndrome, including clinical guidelines, systematic reviews, and primary research.

Cochrane reviews on carpal tunnel syndrome

Cochrane

Cochrane provides systematic reviews of primary research in human health care and health policy. This resource offers numerous evidence-based reviews related to various interventions for carpal tunnel syndrome.

TRIP Database search results for Carpal Tunnel Syndrome

TRIP Database

TRIP Database is a clinical search engine designed to allow users to quickly and easily find high-quality research evidence to support their practice. It aggregates evidence from multiple sources for carpal tunnel syndrome.