Rehabilitation approach to carpal tunnel syndrome: from the literature review to the clinical practice

Introduction: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. In the literature, several conservative treatments have been proposed but, to our notice, a practical and ready-to-use guide as regards different rehabilitation techniques is lacking. In this sense, by combining scientific evidence and expert opinion, the present manuscript aims to display the conservative and rehabilitation approach to this challenging pathology. Methods: From a total of 145 items identified, the authors analyzed 79 articles—excluding studies that had recruited patients without clinical and/or instrumental diagnosis of CTS or those who had undergone surgery. Four categories of nonsurgical approaches have been defined; injections, rehabilitation techniques, orthoses, and physical therapies. Results: Carpal tunnel injection with 5% dextrose, night wrist orthosis, and extracorporeal shockwave therapy seemed to be the most effective nonsurgical treatment in CTS. Considering the poor description of specific upper limb rehabilitation techniques in the literature, an in-depth focus has also been provided based more on the authors’ experience in hand rehabilitation. Conclusions: Future clinical studies are awaited to establish standardized conservative protocols whereby the injection dose/technique, physical therapy, and the specific rehabilitation technique are reported. Further, a better understanding of the dynamic relationship between the median nerve and the nearby soft tissues inside the tunnel (eg, perineural loose connective tissue) would be noteworthy to optimize the treatment outcome and the hand function in the long term.