Outside of an emergency situation, such as a wrist fracture, treatment guidelines for carpal tunnel syndrome generally recommend exhausting non-surgical options before consulting with a surgeon. But how well are guidelines followed? To find out, researchers surveyed 770 members of the American Society for Surgery of the Hand to better understand the current practice patterns regarding the non-surgical care for CTS patients. Roughly half of respondents had two decades or more of experience in the field with 80% completing a residency in orthopedic surgery and 81% either currently have or previously had a subspecialty in hand surgery.
According to the survey, 72.9% of the CTS patients the surgeons consulted with had previously had two or more corticosteroid injections with 41.2% of surgeons recommending an additional injection before recommending surgery. About four-in-five surgeons did not believe oral steroids are effective for managing CTS though they are included in clinical treatment guidelines developed by the American Academy of Orthopedic Surgery (AAOS). The authors of the study note there is a lack of feedback to the patient’s primary care doctor (and other authorities) when these approaches fail, which may perpetuate their use unnecessarily.
The researchers point out that the current AAOS clinical treatment guidelines cite strong evidence to support corticosteroid injections and moderate evidence that oral steroids could improve patient-reported outcomes compared to placebo. The study authors continue by noting a study that found corticosteroid injections may only provide short-term benefits compared to a placebo, and another study that concluded a second corticosteroid injections may not offer additional benefit.
The survey results appear to be contrary to the guidelines put forth by the AAOS, which may be misguiding primary care and general orthopedic physicians. The authors conclude that their findings highlight the importance of better implementation of non-surgical CTS treatment strategies that follow current evidence-based information, rather than following the clinical practice guidelines of the AAOS.
The good news is that the various treatments provided by doctors of chiropractic are highly effective in managing mild-to-moderate CTS as studies have demonstrated that such conservative therapies can be as effective as surgery over the long-term with fewer adverse events.