For Treating Carpal Tunnel, the Best Treatment May Be None

From the WebMD Archives

June 12, 2001 -- Many cases of carpal tunnel syndrome will ultimately improve on their own, without surgical treatment or other types of therapies, according to Italian research published in the June 12 issue of Neurology. The finding could cause doctors and patients to rethink the best way to manage the pain, numbness, and tingling that afflict the hands, wrist, and fingers of people with this common condition. Specifically, it calls into question whether surgery is the only -- or even the best -- way to achieve a definite cure.

Few previous studies have compared what happens to treated patients as opposed to their untreated counterparts, says Andrew Lincoln, ScD, an assistant research professor at Johns Hopkins University's Bloomberg School of Public Health, in Baltimore. Without such studies, says Lincoln, who reviewed the study for WebMD, researchers have tended to attribute improvements in symptoms to their surgical efforts and not to whether the symptoms naturally got better by themselves -- and would have whether the surgery was performed or not.

Researchers at various clinics around Italy studied 196 patients (actually, 274 hands of those 196 patients) for up to 15 months after the initial visit for treatment.

On average, many of the patients seemed to improve -- or at least not worsen -- over the follow-up period, and did so without getting specific treatment other than the occasional painkiller. Patients who had experienced symptoms of carpal tunnel syndrome for shorter amounts of time had higher rates of spontaneous improvement than those who had had symptoms for longer. Younger patients tended to do better than older patients.

Interestingly, patients with more severe symptoms also tended to do better than those with milder symptoms. "That was really surprising," Richard K. Olney, MD, tells WebMD, "that the people with the more severe symptoms... [were] more likely to spontaneously get better."

Olney, a professor of clinical neurology at the University of California, San Francisco, wrote an editorial that accompanied the study. In it, he says that when doctors are faced with severely affected patients, they usually think first about operating, but this research shows they may do better to think twice.

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.