Carpal tunnel syndrome. A common but treatable cause of wrist pain.

Diagnosis of carpal tunnel syndrome is based on a thorough patient history, careful physical examination, and provocative testing. Electrophysiologic testing should be completed before treatment is begun. Conservative therapy is appropriate first-line treatment unless the condition is severely advanced or immediate resolution of symptoms is essential. I recommend use of wrist splints, steroid injection, nonsteroidal antiinflammatory drugs, and pyridoxine, followed by reexamination in three weeks, or earlier if symptoms progress. For persistent or acute symptoms, surgical treatment may be necessary.