Evaluation of Carpal Tunnel Diagnosis, Management, and Outcome in Primary Health Care Center

Abstract

Background: tunnel syndrome (CTS) is one of the commonest conditions encountered in primary care centers as mentioned earlier. CTS of mild to moderate severity can often be effectively treated in a primary care environment. However, many patients being referred immediately to hospital for consideration of surgical decompression. Objective: In this study, we aim to evaluate the available primary care options and their efficacy in dealing with CTS. Methods: PubMed database was used for articles selection, and the following keys used in the mesh ((Carpal tunnel syndrome[Mesh]) AND (Carpal tunnel syndrome/Management[Mesh] OR Carpal tunnel syndrome/Diagnosis[Mesh] OR Carpal tunnel syndrome/ Primary Health Care Center)). 5 studies were enrolled according to our inclusion, and exclusion criteria. Results: Patients successfully treated with wrist splinting alone reported a higher level of satisfaction with their treatment compared to patients who failed wrist splint treatment or had surgical decompressionMechanical traction is associated with fewer surgical interventions compared to care as usual in CTS patients. Reductions in patient-reported symptoms at 6 months’ follow-up was similar in both groups.Steroid injection combined with splinting resulted in modestly greater reduction of symptoms, functional recovery, and improvement of nerve function at 12-week follow-up compared to steroid injection alone. Conclusion: CTS is commonly encountered in primary care. So, a trial of conservative treatment can be done before referral for surgical decompression. Conservative treatment of CTS had shown a clear reduction in hand surgery waitlists, thus reduction in expenditures and costs. Wrist splinting is recommended as first line treatment for patients with symptoms of CTS. Other methods of non-surgical treatment include steroid injection, osteopathic manipulative therapy, mechanical wrist traction and combining wrist splinting with steroid injection or with NSAIDs use. Referral for surgical decompression may be a more appropriate option when the level of numbness and other symptoms are getting worse, or when conservative management has failed and is likely to lead to dissatisfaction.