Limited draping and local anesthesia only for a mini-open carpal tunnel release
Courtesy of Robin Kamal, MD, FAAOS
Published 6/20/2024
During its recent meeting, the AAOS Board of Directors (BOD) approved an update to the 2016 AAOS Clinical Practice Guideline (CPG) for the Management of Carpal Tunnel Syndrome (CTS). This new CPG focuses on diagnosis and treatment of adult patients (aged >18 years) who are exhibiting symptoms that may be associated with CTS.
The prior CPG included 35 recommendations covering aspects such as diagnosis, prognosis, operative and nonoperative treatments, and postoperative care associated with CTS. The 2016 CPG also made recommendations regarding the short-term effects of interventions, whereas the 2024 CPG exclusively evaluated the long-term, disease-modifying benefits of various treatment options.
The updated CPG resulted in five strong and three moderate-strength recommendations, including one new strong recommendation that platelet-rich plasma injections do not provide any long-term benefits in the nonoperative treatment of CTS. Other strong recommendations include: use of the CTS-6 to diagnose CTS; the absence of long-term benefits of corticosteroid injections to alleviate CTS symptoms; equivalency of patient-reported outcomes with mini-open versus endoscopic carpal tunnel release; the use of local anesthesia alone for carpal tunnel release; and the use of NSAIDs and/or acetaminophen for postoperative pain management.
Moderate-strength recommendations include a recommendation against the use of MRI and upper-limb neurodynamic testing to diagnose CTS; against routinely prescribing postoperative supervised therapy; and against the use of postoperative immobilization.
In addition to the eight recommendations, 12 options were formulated. Options are used when there is little, conflicting, or no evidence on a topic. These options included one new limited-strength option and four new consensus options.
Representatives from the American Society for Surgery of the Hand, the American Association for Hand Surgery, the American College of Occupational and Environmental Medicine, the American Society of Hand Therapists, the American College of Radiology, and the American Academy of Physical Medicine and Rehabilitation participated in the development of this guideline. The updated CPG and accompanying documentation are available at orthoguidelines.org or via the OrthoGuidelines app.