The American Academy
of Orthopaedic Surgeons (AAOS) has approved and released an evidence-based
clinical practice guideline on “The Treatment of Carpal Tunnel Syndrome.”
“Carpal Tunnel Syndrome, otherwise known as CTS, is among the most
common disorders of the upper extremity. It affects up to ten 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,” said Michael Keith, M.D., Chair of the AAOS work group responsible
for creating the new guideline.
— According to the National Center for Health Statistics, in 2005, an
estimated 3.1 million people sought help from physicians for the
treatment of CTS.
“The Academy created this clinical practice guideline to improve
patient care for those suffering from Carpal Tunnel Syndrome,” stated Dr.
Keith. “The document serves as a point of reference and educational tool
for both family practitioners and orthopaedic surgeons, streamlining
possible treatment processes for this ever-so common ailment.”
In June 2007, the Journal of the Academy of Orthopaedic Surgeons
(JAAOS) reported about 500,000 CTS surgical procedures are performed each
year. The same study also reported the economic impact due to CTS is
estimated to exceed $2 billion annually.
The final CTS Treatment guideline contains nine recommendations which
include both 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
— Carpal tunnel release surgery
After doing a thorough analysis of the current literature, the work
group found no evidence that supports the following treatments:
— Heat therapy
— Electric stimulation
— Massage therapy
— Magnet therapy
— Nutritional supplements
“This guideline is not intended to stand alone,” added Dr. Keith. “It
can be used as a starting point for physicians and can open up the lines of
patient-physician communication on possible treatment options.”
As new research, knowledge and literature on CTS becomes available,
this guideline will be reviewed and re-evaluated by the Guidelines and
Technology Oversight Committee. It will be considered for updating in three
to five years, which is consistent with evidence-based standards.
The AAOS has released other evidence-based guidelines on
musculoskeletal topics, including:
— Diagnosis of Carpal Tunnel Syndrome
— Prevention of Symptomatic Pulmonary Embolism (PE)
This guideline, which is aimed towards the treatment of Carpal Tunnel
Syndrome in adults, was 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 and/or diagnosis.
The entire process from beginning to end lasted about eighteen months and
included a review panel consisting of internal and external committees,
public commentaries and final approval by the AAOS Board of Directors.
The full guideline along with all supporting documentation is available
on the AAOS website: aaos/guidelines
American Academy of Orthopaedic Surgeons