AAOS Clinical Practice Guidelines for Carpal Tunnel Syndrome: Synopsis and Practice Implications

DESCRIPTION: Carpal tunnel syndrome is a common peripheral nerve compression frequently encountered in primary care and internal medicine settings. The American Academy of Orthopaedic Surgeons (AAOS) developed updated evidence-based clinical practice guidelines in 2024 to improve outcomes and optimize diagnosis and management. This synopsis highlights recommendations most relevant to nonoperative clinicians, with an emphasis on efficient diagnosis, management, and appropriate referral. METHODS: The AAOS guideline was developed by a multidisciplinary panel using a systematic review of the available literature. Guideline development involved reviewing the evidence, formulating recommendations, and grading them based on the strength of evidence and consensus, in line with established standards for trustworthy clinical practice guidelines. RECOMMENDATIONS: The guidelines emphasize that carpal tunnel syndrome is a clinical diagnosis based on characteristic symptoms and examination findings. Strong evidence supports the use of validated clinical tools, such as the Carpal Tunnel Syndrome-6 (CTS-6), in patients with typical presentations, without routine reliance on ultrasonography or electrodiagnostic testing, which may be reserved for diagnostic uncertainty or potentially recurrent cases. Nonoperative therapies may provide short-term symptom relief; for example, corticosteroid injection demonstrates short-term benefit but does not alter the long-term disease course. Many commonly used interventions, including therapeutic ultrasound, oral corticosteroids, nonsteroidal anti-inflammatory drugs, and platelet-rich plasma injections, lack evidence of clinical benefit and thus are not recommended. Surgical carpal tunnel release, when pursued for moderate to severe symptoms, thenar atrophy, or failure of nonoperative management, may be performed via open or endoscopic release. The guidelines recommend against routine pre-operative testing in otherwise healthy patients. These recommendations support efficient diagnosis, appropriate management, and timely referral while reducing unnecessary testing and low-value care.