For Treating Carpal Tunnel, the Best Treatment May Be None
But Lincoln isn't all that surprised. And he says this study supports taking a wait-and-see approach in carpal tunnel patients, especially those in whom neurological tests are inconsistent or absent and in those who can afford to wait longer before having surgery.
But others aren't so convinced.
"Is there any way to predict who is going to get better?" asks Michael Rubin, MD, director of the neuromuscular service at New York Weill Cornell Medical Center. "If you come to my office, and you are worse than the next guy, ... I will treat you like you are worse; if you are better, I will treat you like you are better." Rubin was not involved in the study.
Lincoln says he'd be curious to learn why these patients are spontaneously getting better.
"I was interested to see that 68% [of patients] reduced their hand stress, and 32% changed their work or hobby activity after they were initially diagnosed," he says. "So what we don't know ... is whether this spontaneous improvement ... was simply the result of decreased occupational or recreational exposure to hand stress."
"The bottom line isn't in quite yet," agrees Olney, who says that when people get carpal tunnel syndrome, it is important to work out a well-defined plan for treatment, but what is most effective is still not clear. "I think progress is being made, but we still have more work until we can say we have the final recommendation to give the American public."
Until more is known, the study authors acknowledge that while the results of their study should be considered, they aren't definitive, and evaluations should be made on a case-by-case basis.