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Health Protocols

Carpal Tunnel Syndrome

Novel and Emerging Strategies

Sonographically Guided Percutaneous Needle Release

Carpal tunnel release surgery, whether traditional or endoscopic (minimally invasive), poses greater risk than conservative treatment. Sonographically guided percutaneous needle release is an innovative method that uses ultrasound to visualize the wrist while a fine needle decompresses the carpal tunnel by releasing the transverse carpal ligament. This approach may provide similar results to minimally invasive surgery with lower risk and recovery time (Schreiber 2014; McShane 2012; Kerasnoudis 2012; Nakamichi 2010). Additional controlled studies are needed to confirm the potential of this treatment.

Low-Level Laser Therapy

An interesting approach to treating CTS involves the use of a low-level (low-power) laser, known as low-level laser therapy (LLLT), to stimulate the median nerve (Fusakul 2014). This modality has shown an ability to enhance some aspects of median nerve function (Basford 1993). Several clinical studies have shown LLLT improves various symptoms related to CTS. One study showed LLLT to be as effective as surgical treatment for mild-to-moderate CTS, while another demonstrated the procedure to be as cost-effective as surgery (Elwakil 2007; Chang 2008; Evcik 2007; Shooshtari 2008; Fusakul 2014). Observed benefits of LLLT include:

  • Improved grip strength (Evcik 2007; Shooshtari 2008; Fusakul 2014)
  • Alleviation of pain (Chang 2008; Dakowicz 2011)
  • Improved nerve conduction study parameters (Yagci 2009; Shooshtari 2008; Fusakul 2014)
  • Reduction of paresthesia (tingling) and numbness (Shooshtari 2008)

Microwave Heat Treatment

Microwave hypothermia, which uses microwaves to heat the skin to about 39.7°C (103.5°F), may be helpful for CTS. A 2011 trial used microwave hyperthermia to treat 22 subjects with mild-to-moderate CTS. Over three weeks, 11 subjects underwent six microwave hyperthermia treatments and 11 underwent six sham (placebo) treatments. After three weeks, significant reductions in pain and significant improvements in hand function were reported in the microwave hyperthermia-treated group but not in the sham-treated group (Frasca 2011).