Recent Advances in the Understanding and Management of Carpal Tunnel Syndrome: a Comprehensive Review


Purpose of Review

Carpal tunnel syndrome (CTS) is an entrapment neuropathy that involves the compression of the median nerve at the wrist and is considered the most common of all focal entrapment mononeuropathies. CTS makes up 90% of all entrapment neuropathies diagnosed in the USA and affects millions of Americans.

Recent Findings

Age and gender likely play a role in the development of CTS, but additional studies may further elucidate these associations. Of known associated risk factors, diabetes mellitus seems to have the greatest association with CTS. One of the most commonly reported symptoms in CTS is a “pins-and-needles” sensation in the first three fingers and nocturnal burning pain that is relieved with activity upon waking. Treatment for CTS is variable depending on the severity of symptoms.


Conservative management of CTS is usually considered first-line therapy. In cases of severe sensory or motor deficit, injection therapy or ultimately surgery may then be considered. Still CTS is often difficult to treat and may be reoccurring. Novel treatment modalities such as laser and shockwave therapy have demonstrated variable efficacy though further studies are needed to assess for safety and effect. Given the unknown and potentially complex etiology of CTS, further studies are needed to explore combinations of diagnostic and therapeutic modalities.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.


    Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

    1. 1.

      Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, et al. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol. 2016;15:1273–84.

    2. 2.

      Eroğlu A, Sarı E, Topuz AK, Şimşek H, Pusat S. Recurrent carpal tunnel syndrome: evaluation and treatment of the possible causes. World J Clin Cases. 2018;6(10):365–72.

    3. 3.

      Wang L. Guiding treatment for carpal tunnel syndrome. Phys Med Rehabil Clin N Am. 2018;29:751–60.

    4. 4.

      Gillig JD, White SD, Rachel JN. Acute carpal tunnel syndrome. A Review of Current Literature Orthop Clin North Am. 2016;47(3):599–607.

    5. 5.

      Minieka MM, Nishida T, Benzon H. Entrapment neuropathies. In: Essentials of pain medicine. Third Edit. Elsevier Inc.; 2011. p. 395–403.

    6. 6.

      Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, et al. Carpal tunnel syndrome: diagnosis and management. Am Fam Physician. 2016;94(12):993–9.

    7. 7.

      Sharma D, Jaggi AS, Bali A. Clinical evidence and mechanisms of growth factors in idiopathic and diabetes-induced carpal tunnel syndrome. Eur J Pharmacol. 2018;837(August):156–63.

    8. 8.

      Festen-Schrier VJMM, Amadio PC. The biomechanics of subsynovial connective tissue in health and its role in carpal tunnel syndrome. J Electromyogr Kinesiol. 2018;38(September 2017):232–9.

    9. 9.

      Sucher BM, Schreiber AL. Carpal tunnel syndrome diagnosis. Phys Med Rehabil Clin N Am. 2014;25(2):229–47.

    10. 10.

      Sonoo M, Menkes DL, Bland JDP, Burke D. Nerve conduction studies and EMG in carpal tunnel syndrome: do they add value? Clin Neurophysiol Pract. 2018;3:78–88.

    11. 11.

      Fowler JR, Munsch M, Tosti R, Hagberg WC, Imbriglia JE. Comparison of ultrasound and electrodiagnostic study using a validated clinical tool as the reference standard. J Bone Jt Surg. 2014;96(17):e148(1)–4).

    12. 12.

      Duckworth AD, Jenkins PJ, McEachan JE. Diagnosing carpal tunnel syndrome. J Hand Surg [Am]. 2014;39(7):1403–7.

    13. 13.

      Chammas M, Boretto J, Burmann LM, Ramos RM, Neto FS, Silva JB. Carpal tunnel syndrome – part II (treatment). Rev Bras Ortop (English Ed). 2014;49(5):437–45.

    14. 14.

      Martins RS, Siqueira MG. Conservative management of carpal tunnel syndrome. J Hand Surg [Am]. 1995;20(4):700.

    15. 15.

      •• Burton CL, Chesterton LS, Chen Y, Van Der Windt DA. Clinical course and prognostic factors in conservatively managed carpal tunnel syndrome: a systematic review. Arch Phys Med Rehabil. 2016;97(5):836–52 A systematic review of outcomes of CTS following conservative management.

    16. 16.

      Huisstede BM, van den Brink J, Randsdorp MS, Geelen SJ, Koes BW. Effectiveness of surgical and postsurgical interventions for carpal tunnel syndrome—a systematic review. Arch Phys Med Rehabil. 2018;99(8):1660–1680.e21.

    17. 17.

      Ingram J, Mauck BM, Thompson NB, Calandruccio JH. Cost, value, and patient satisfaction in carpal tunnel surgery. Orthop Clin North Am. 2018;49(4):503–7.

    18. 18.

      Karl JW, Gancarczyk SM, Strauch RJ. Complications of carpal tunnel release. Orthop Clin North Am. 2016;47(2):425–33.

    19. 19.

      Beck JD, Brothers JG, Maloney PJ, Deegan JH, Tang X, Klena JC. Predicting the outcome of revision carpal tunnel release. J Hand Surg [Am]. 2012;37(2):282–7.

    20. 20.

      Rajeswaran G, Healy JC, Lee JC. Percutaneous release procedures: trigger finger and carpal tunnel. Semin Musculoskelet Radiol. 2016;20(5):432–40.

    21. 21.

      Vasiliadis HS, Nikolakopoulou A, Shrier I, Lunn MP, Brassington R, Scholten RJP, et al. Endoscopic and open release similarly safe for the treatment of carpal tunnel syndrome. A systematic review and meta-analysis. PLoS One. 2015;10(12):1–16.

    22. 22.

      Vasiliadis H, Georgoulas P, Shrier I, Salanti G, Rjpm S. Endoscopic release for carpal tunnel syndrome ( protocol ). 2014;(1).

    23. 23.

      So H, Chung VCH, Cheng JCK, Yip RML. Local steroid injection versus wrist splinting for carpal tunnel syndrome: a randomized clinical trial. Int J Rheum Dis. 2018;21(1):102–7.

    24. 24.

      • Wang JC, Liao KK, Lin KP, Chou CL, Yang TF, Huang YF, et al. Efficacy of combined ultrasound-guided steroid injection and splinting in patients with carpal tunnel syndrome: a randomized controlled trial. Arch Phys Med Rehabil. 2017;98(5):947–56 An evaluation of steroid injection for the management of CTS.

    25. 25.

      Guo XY, Xiong MX, Zhao Y, He FD, Cheng XQ, Wu YY, et al. Comparison of the clinical effectiveness of ultrasound-guided corticosteroid injection with and without needle release of the transverse carpal ligament in carpal tunnel syndrome. Eur Neurol. 2017;78(1–2):33–40.

    26. 26.

      Wu YT, Ho TY, Chou YC, Ke MJ, Li TY, Huang GS, et al. Six-month efficacy of platelet-rich plasma for carpal tunnel syndrome: a prospective randomized, singleblind controlled trial. Sci Rep. 2017;7(1):1–11.

    27. 27.

      Malahias M-A, Chytas D, Mavrogenis AF, Nikolaou VS, Johnson EO, Babis GC. Platelet-rich plasma injections for carpal tunnel syndrome: a systematic and comprehensive review. Eur J Orthop Surg Traumatol. 2018

    28. 28.

      •• Raeissadat SA, Karimzadeh A, Hashemi M, Bagherzadeh L. Safety and efficacy of platelet-rich plasma in treatment of carpal tunnel syndrome; a randomized controlled trial. BMC Musculoskelet Disord. 2018;19(1):1–6 An evaluation of PRP injection for the management of CTS.

    29. 29.

      Li ZJ, Wang Y, Zhang HF, Ma XL, Tian P, Huang Y. Effectiveness of low-level laser on carpal tunnel syndrome: a meta-analysis of previously reported randomized trials. Med (United States). 2016;95(31):1–6.

    30. 30.

      Raissi GR, Ghazaei F, Forogh B, Madani SP, Daghaghzadeh A, Ahadi T. The effectiveness of radial extracorporeal shock waves for treatment of carpal tunnel syndrome: a randomized clinical trial. Ultrasound Med Biol. 2017;43(2):453–60.

    31. 31.

      Wu YT, Ke MJ, Chou YC, Chang CY, Lin CY, Li TY, et al. Effect of radial shock wave therapy for carpal tunnel syndrome: a prospective randomized, double-blind, placebo-controlled trial. J Orthop Res. 2016;34(6):977–84.

    Download references

    Author information

    Correspondence to Ivan Urits.

    Ethics declarations

    Conflict of Interest

    Ivan Urits, Kyle Gress, Karina Charipova, Vwaire Orhurhu, and Omar Viswanath declare no conflict of interest. Alan D. Kaye discloses that he is on the Speakers Bureau for Depomed, Inc., and Merck.

    Human and Animal Rights and Informed Consent

    This article does not contain any studies with human or animal subjects performed by any of the authors.

    Additional information

    Publisher’s Note

    Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

    This article is part of the Topical Collection on Hot Topics in Pain and Headache

    Rights and permissions

    Reprints and Permissions

    About this article

    Verify currency and authenticity via CrossMark

    Cite this article

    Urits, I., Gress, K., Charipova, K. et al. Recent Advances in the Understanding and Management of Carpal Tunnel Syndrome: a Comprehensive Review. Curr Pain Headache Rep 23, 70 (2019) doi:10.1007/s11916-019-0811-z

    Download citation


    • Carpal tunnel syndrome
    • Entrapment neuropathy
    • Chronic pain management
    • Endoscopic release
    • Injection therapy