Condition

Carpal Tunnel Syndrome

Nerve compression in the wrist causing hand numbness and pain

400M
People Affected
60
Active Trials
20M
New Cases/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Carpal Tunnel Release Surgery
92% Effectiveness• 90% Confidence• 60% Safety• 85 trials• 50K participants
HIGH EvidenceExcellent ValueDose: Surgical procedure
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
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60
DangerousModerateSafe

Time to Effect

Immediate relief of nocturnal symptoms, full recovery 3-6 months

Duration

One-time procedure, recovery period of weeks to months

Response Rate

93%

Remission Rate

85%

Number Needed to Treat (NNT)

2

Number Needed to Harm (NNH)

50

Common Side Effects:

Scar tenderness/pain: 15%
Pillar pain: 20%
Infection: 2%
Nerve damage (rare): 1%
Incomplete relief/recurrence: 7%

Annual Cost of Care

Drug Cost

$100

Monitoring

$500

Side Effects

$400

Total Annual

$7,000

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.7

ICER

$25,000/QALY

Cost per Remission

$8,235

Cost per Responder

$7,778

Treatment Outcomes
Primary Outcomes
Carpal Tunnel Symptom Severity (BCTQ-SSS)3.5/5.0 points
-43% (-1.5 points)
Carpal Tunnel Functional Status (BCTQ-FSS)3.0/5.0 points
-37% (-1.1 points)
Hand Pain Intensity (NRS)7/10 points
-57% (-4 points)
Secondary Benefits
Health-Related Quality of Life (SF-36 Physical Component Summary)35 points
+23% (+8 points)
Sleep Disturbances due to Pain (NRS)6/10 points
-50% (-3 points)
Grip Strength (dominant hand)25 kg
+20% (+5 kg)
Common Side Effects
Scar tenderness/pain
+15%
Pillar pain
+20%
Infection
+2%

Clinical Trial Phases:

Phase 4
2
Corticosteroid Injection (e.g., Methylprednisolone)
80% Effectiveness• 85% Confidence• 70% Safety• 200 trials• 20K participants
HIGH EvidenceGood ValueDose: 10-20 mg Methylprednisolone or equivalent, mixed with local anesthetic
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
70
DangerousModerateSafe

Time to Effect

24-72 hours

Duration

Single injection, effects last 1-6 months; repeat injections discouraged

Response Rate

75%

Remission Rate

40%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

150

Common Side Effects:

Injection site pain/bruising: 15%
Local skin atrophy/depigmentation: 7%
Infection: 0.5%
Temporary flare of symptoms: 3%

Annual Cost of Care

Drug Cost

$50

Monitoring

$300

Side Effects

$50

Total Annual

$400

Cost-Effectiveness

GOOD

QALYs Gained

0.2

Cost per Remission

$1,000

Cost per Responder

$533

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+80%
Response Rate
+75%
Remission Rate
+40%
Common Side Effects
Injection site pain/bruising
+15%
Local skin atrophy/depigmentation
+7%
Infection
+0.5%

Clinical Trial Phases:

Phase 4
3
Night Splinting / Wrist Bracing
70% Effectiveness• 80% Confidence• 95% Safety• 2 trials• 15K participants
HIGH EvidenceExcellent ValueDose: Wear at night and/or during aggravating activities
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
95
DangerousModerateSafe

Time to Effect

Few days to 2 weeks

Duration

Typically 4-12 weeks initially, then as needed for recurrence, often long-term night use

Response Rate

65%

Remission Rate

30%

Number Needed to Treat (NNT)

5

Common Side Effects:

Skin irritation/discomfort: 10%
Impaired sleep (initial): 3%

Annual Cost of Care

Drug Cost

$0

Monitoring

$100

Side Effects

$0

Total Annual

$200

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.1

Cost per Remission

$667

Cost per Responder

$308

Treatment Outcomes
Primary Outcomes
BCTQ Symptom Severity Scale (SSS)BCTQ-SSS score: 3.5/5
-23% (-0.8 points)
BCTQ Functional Status Scale (FSS)BCTQ-FSS score: 3.0/5
-20% (-0.6 points)
Night-time Pain (NPRS)NPRS score: 7/10
-36% (-2.5 points)
Frequency of Night-time Paresthesia Episodes3 episodes per night
-50% (-1.5 episodes per night)
Secondary Benefits
QuickDASH ScoreQuickDASH score: 45/100
-22% (-10 points)
Sleep Quality (PSQI)PSQI score: 11/21
-27% (-3 points)
Grip Strength (Affected Hand)30 kg
+7% (+2 kg)
Common Side Effects
Skin irritation/discomfort
+10%
Impaired sleep (initial)
+3%

Clinical Trial Phases:

Phase 4
4
Physical Therapy / Occupational Therapy
65% Effectiveness• 70% Confidence• 95% Safety• 2 trials• 8K participants
MODERATE EvidenceGood ValueDose: Varies based on program; includes nerve gliding, stretching, strengthening, manual therapy
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
95
DangerousModerateSafe

Time to Effect

3-6 weeks

Duration

Typically 6-12 weeks, 2-3 sessions per week

Response Rate

65%

Remission Rate

20%

Number Needed to Treat (NNT)

7

Common Side Effects:

Temporary discomfort: 7%

Annual Cost of Care

Drug Cost

$0

Monitoring

$1,000

Side Effects

$0

Total Annual

$1,000

Cost-Effectiveness

GOOD

QALYs Gained

0.1

Cost per Remission

$5,000

Cost per Responder

$1,538

Treatment Outcomes
Primary Outcomes
Pain Intensity6/10 on Numeric Rating Scale
-33.3% (-2 points on NRS)
Carpal Tunnel Symptom Severity Scale (CTSS-SSS)2.8/5 (higher is worse)
-25% (-0.7 points on CTSS-SSS)
Carpal Tunnel Functional Status Scale (CTSS-FSS)2.5/5 (higher is worse)
-24% (-0.6 points on CTSS-FSS)
Secondary Benefits
Dominant Hand Grip Strength20 kg
+15% (+3 kg)
Dominant Hand Key Pinch Strength4 kg
+10% (+0.4 kg)
Sleep Disturbance7/10 on Sleep Disturbance Scale
-28.6% (-2 points on Sleep Disturbance Scale)
Common Side Effects
Temporary discomfort
+7%

Clinical Trial Phases:

Phase 4
5
Oral Corticosteroids (e.g., Prednisone)
65% Effectiveness• 75% Confidence• 50% Safety• 50 trials• 5K participants
MODERATE EvidenceGood ValueDose: e.g., Prednisone 20 mg daily for 2 weeks, then taper
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
50
DangerousModerateSafe

Time to Effect

24-48 hours

Duration

Short course, typically 2-4 weeks with tapering

Response Rate

65%

Remission Rate

25%

Number Needed to Treat (NNT)

6

Number Needed to Harm (NNH)

15

Common Side Effects:

Insomnia, mood changes: 15%
Fluid retention, weight gain: 10%
Increased appetite: 7%
Gastric irritation: 3%
Increased blood sugar: 3%

Annual Cost of Care

Drug Cost

$50

Monitoring

$100

Side Effects

$50

Total Annual

$200

Cost-Effectiveness

GOOD

QALYs Gained

0.08

Cost per Remission

$800

Cost per Responder

$308

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+65%
Response Rate
+65%
Remission Rate
+25%
Common Side Effects
Insomnia, mood changes
+15%
Fluid retention, weight gain
+10%
Increased appetite
+7%

Clinical Trial Phases:

Phase 4
6
Yoga / Nerve Gliding Exercises
55% Effectiveness• 65% Confidence• 95% Safety• 30 trials• 3K participants
MODERATE EvidenceExcellent ValueDose: 15-30 minutes, 2-3 times daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
95
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

Ongoing, daily or several times a week

Response Rate

55%

Remission Rate

15%

Number Needed to Treat (NNT)

9

Common Side Effects:

Temporary soreness/fatigue: 7%

Annual Cost of Care

Drug Cost

$0

Monitoring

$100

Side Effects

$0

Total Annual

$100

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.05

Cost per Remission

$667

Cost per Responder

$182

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+55%
Response Rate
+55%
Remission Rate
+15%
Common Side Effects
Temporary soreness/fatigue
+7%

Clinical Trial Phases:

Phase 4