The TCL can be divided by various surgical techniques, including conventional open carpal tunnel release (OCTR), mini-OCTR, and endoscopic carpal tunnel release (ECTR). 8) Carpal tunnel release (CTR) with TCL division is accepted as the most reliable procedure for relieving symptoms. In the recent literature, surgical treatment has been reported to be more effective than splinting 7) and other conservative treatment. Despite the equivocal nature of CTS etiology, simple decompression of the median nerve by division of the transverse carpal ligament (TCL) is the treatment of choice and is considered to yield excellent results in 75% of the patients. When conservative treatment fails, surgical treatment is considered. 5) Further research is required to clarify the appropriate injection method and the optimum preparation, dose, and volume of corticosteroid. 4) The effect of corticosteroids or local anesthetic agents on the peripheral nerve fibers or epinerium cells reported traumatic epineural injury, axonal degeneration and intrafascial syrinx created by hydrostatic pressure. This eventually reduces the mechanical strength of the tendon and leading to further degeneration. 3)Ĭorticosteroid treatment is effective in reducing inflammation and edema of synovium and tendons, it also has harmful effect on tenocyte function by reducing collagen and proteoglycan synthesis. Subsequent research has suggested that the therapeutic effect of wrist splinting arises from minimizing carpal tunnel pressure. The rationale for wrist splint is based on observations that CTS symptoms improve with rest and aggravate with activity. Splinting, local injection of corticosteroids into the carpal tunnel, and oral corticosteroid treatment have proven effective in some cases. However, in recent practice, treatment should be selected considering the various factors, such as the stage of the disease, the severity of the symptoms, or the patient's preference. When the pathophysiology of idiopathic CTS remained unclear, definitive treatment strategies have not been established.
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