Which treatment option best describes the first-line management for Carpal Tunnel Syndrome?

• A. Physical therapy only
• B. NSAIDs/Acetaminophen, splint, steroid injections, surgical release (lastly)
• C. Corticosteroid injections only
• D. Surgery for decompression first-line

Answer: (B)

First-line management for Carpal Tunnel Syndrome is a stepwise, nonoperative approach aimed at reducing pressure on the median nerve and easing symptoms. The key starting move is a wrist splint worn at night to keep the wrist in a neutral position and prevent flexion that worsens compression. Pain relief with NSAIDs or acetaminophen is common, though these do not address the underlying cause. Corticosteroid injections into the carpal tunnel can provide rapid and meaningful relief for many patients and are used when symptoms persist despite splinting. If symptoms continue despite these measures or there’s evidence of nerve impairment, surgical release to decompress the tunnel is considered, but it’s reserved for cases that don’t respond to conservative therapy. This progression—from splinting and analgesia to injections, with surgery as a last resort—fits the typical first-line approach.