Carpal Tunnel Syndrome: Efficacy of Non-Operative Treatment
This is a very straightforward study of 5482 carpal tunnel patients treated non-operatively. Although there was some initial modest abatement of symptoms in approximately 17% of patients treated by NSAIDS, NSAIDS and oral steroids, steroid injection, galvanic stimulation, or cold laser therapy, there was rapid recurrence of symptoms within 4 to 9 weeks. All of the modalities were failures at 5 years to the following extent:
- NSAIDS: 99% failure
- NSAIDS and oral steroids: 98% failure
- Steroid injection: 99% failure
- Galvanic stimulation: 100% failure
- Cold laser therapy: 100% failure
Therefore, non-operative treatment of carpal tunnel syndrome fails 98-100% of the time. These costly treatments are often invoked for fear of the painful, prolonged recovery period following an open CTR. We have reported elsewhere the safety and efficacy of the Brown Procedure endoscopic tunnel release (not to be confused with other techniques) to be approximately 98% successful without iatrogenic nerve or vascular injury and with full return to activity in 8.7 days. We have also reported that permanent nerve damage can occur with only 8 weeks duration of symptoms with electrodiagnostically “mild” CTS. We, therefore, recommend abandonment of these non-operative modalities for the more conservative Brown Procedure, ideally performed at the 8 week point in duration of symptoms. The goal of this treatment is to eliminate the pressure on the nerve, not simply to provide palliative relief to the sufferer until permanent nerve damage ensues and unbearable pain mandates surgical release.
Michael G. Brown, M.D., Randolph Lopez, M.D., Andrew Lee, M.D., Christopher Hankins, M.D., Joseph Dang, M.D., Brown Hand Center, Houston, Texas
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