Recent Advances in the Understanding and Management of Carpal Tunnel Syndrome: a Comprehensive Review

  • Ivan UritsEmail author
  • Kyle Gress
  • Karina Charipova
  • Vwaire Orhurhu
  • Alan D. Kaye
  • Omar Viswanath
Hot Topics in Pain and Headache (N Rosen, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Hot Topics in Pain and Headache


Purpose of Review

Carpal tunnel syndrome (CTS) is an entrapment neuropathy that involves the compression of the median nerve at the wrist and is considered the most common of all focal entrapment mononeuropathies. CTS makes up 90% of all entrapment neuropathies diagnosed in the USA and affects millions of Americans.

Recent Findings

Age and gender likely play a role in the development of CTS, but additional studies may further elucidate these associations. Of known associated risk factors, diabetes mellitus seems to have the greatest association with CTS. One of the most commonly reported symptoms in CTS is a “pins-and-needles” sensation in the first three fingers and nocturnal burning pain that is relieved with activity upon waking. Treatment for CTS is variable depending on the severity of symptoms.


Conservative management of CTS is usually considered first-line therapy. In cases of severe sensory or motor deficit, injection therapy or ultimately surgery may then be considered. Still CTS is often difficult to treat and may be reoccurring. Novel treatment modalities such as laser and shockwave therapy have demonstrated variable efficacy though further studies are needed to assess for safety and effect. Given the unknown and potentially complex etiology of CTS, further studies are needed to explore combinations of diagnostic and therapeutic modalities.


Carpal tunnel syndrome Entrapment neuropathy Chronic pain management Endoscopic release Injection therapy 


Compliance with Ethical Standards

Conflict of Interest

Ivan Urits, Kyle Gress, Karina Charipova, Vwaire Orhurhu, and Omar Viswanath declare no conflict of interest. Alan D. Kaye discloses that he is on the Speakers Bureau for Depomed, Inc., and Merck.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ivan Urits
    • 1
    Email author
  • Kyle Gress
    • 2
  • Karina Charipova
    • 2
  • Vwaire Orhurhu
    • 1
  • Alan D. Kaye
    • 3
  • Omar Viswanath
    • 4
    • 5
    • 6
  1. 1.Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain MedicineHarvard Medical SchoolBostonUSA
  2. 2.Georgetown University School of MedicineWashingtonUSA
  3. 3.Department of AnesthesiologyLouisiana State University Health Sciences CenterNew OrleansUSA
  4. 4.Valley Anesthesiology and Pain ConsultantsPhoenixUSA
  5. 5.Department of AnesthesiologyUniversity of Arizona College of Medicine-PhoenixPhoenixUSA
  6. 6.Department of AnesthesiologyCreighton University School of MedicineOmahaUSA

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