多达三分之一的腕管综合征患者未经治疗即可自动改善,尤其是年轻女性(这一发现可能反映了妊娠引发的腕管综合征的自然病程)。[9]Stevens JC, Sun S, Beard CM, et al. Carpal tunnel syndrome in Rochester, Minnesota, 1961 to 1980. Neurology. 1988;38:134-138.http://www.ncbi.nlm.nih.gov/pubmed/3336444?tool=bestpractice.com[78]Padua L, Padua R, Aprile I, et al. Multiperspective follow-up of untreated carpal tunnel syndrome: a multicenter study. Neurology. 2001;56:1459-1466.http://www.ncbi.nlm.nih.gov/pubmed/11402101?tool=bestpractice.com
手腕夹板
大多数研究表明,数周或数月后,夹板疗法的症状改善率约为70%。[93]Manente G, Torrieri F, Di Blasio F, et al. An innovative hand brace for carpal tunnel syndrome: a randomized controlled trial. Muscle Nerve. 2001;24:1020-1025.http://www.ncbi.nlm.nih.gov/pubmed/11439376?tool=bestpractice.com[83]Walker WC, Metzler M, Cifu DX, et al. Neutral wrist splinting in carpal tunnel syndrome: a comparison of night-only versus full-time wear instructions. Arch Phys Med Rehabil. 2000;81:424-429.http://www.ncbi.nlm.nih.gov/pubmed/10768530?tool=bestpractice.com[81]Burke DT, Burke MM, Stewart GW, et al. Splinting for carpal tunnel syndrome: in search of the optimal angle. Arch Phys Med Rehabil. 1994;75:1241-1244.http://www.ncbi.nlm.nih.gov/pubmed/7979936?tool=bestpractice.com[79]Crow RS. Treatment of the carpal-tunnel syndrome. Br Med J. 1960;1:1611-1615.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1968011/pdf/brmedj02921-0049.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/13813041?tool=bestpractice.com[80]Kruger VL, Kraft GH, Deitz JC, et al. Carpal tunnel syndrome: objective measures and splint use. Arch Phys Med Rehabil. 1991;72:517-520.http://www.ncbi.nlm.nih.gov/pubmed/2059127?tool=bestpractice.com延长治疗时间似乎成功率较低,对重度腕管综合征的效果也不太理想。
皮质类固醇注射
大多数研究表明,注射后6个月内的成功率介于60%~70%。[85]Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev. 2007;(2):CD001554.http://www.ncbi.nlm.nih.gov/pubmed/17443508?tool=bestpractice.com
手术
尚没有研究将手术与安慰剂或无治疗进行比较,但是在其他的比较研究中,手术疗法的成功率约为80%~90%。[94]Gerritsen AA, de Vet HC, Scholten RJ, et al. Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomized controlled trial. JAMA. 2002;288:1245-1251.http://jama.ama-assn.org/cgi/content/full/288/10/1245http://www.ncbi.nlm.nih.gov/pubmed/12215131?tool=bestpractice.com[95]Ly-Pen D, Andreu JL, de Blas G, et al. Surgical decompression versus local steroid injection in carpal tunnel syndrome: a one-year, prospective, randomized, open, controlled clinical trial. Arthritis Rheum. 2005;52:612-619.http://onlinelibrary.wiley.com/doi/10.1002/art.20767/fullhttp://www.ncbi.nlm.nih.gov/pubmed/15692981?tool=bestpractice.com[96]Verdugo RJ, Salinas RA, Castillo JL, Cea JG. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev. 2008;(4):CD001552.http://www.ncbi.nlm.nih.gov/pubmed/18843618?tool=bestpractice.com手术后,很少有证据表明任何特定的康复计划相对于另一种是有优势的;因此,选择基于病人和临床医生的偏好而定。[90]Peters S, Page MJ, Coppieters MW, et al. Rehabilitation following carpal tunnel release. Cochrane Database Syst Rev. 2016;(2):CD004158.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004158.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/26884379?tool=bestpractice.com