Background and purpose
An analysis of carpal tunnel syndrome (G56.0) using the 2020 statistical data from the Health Insurance Review and Assessment Service showed that 166,094 individuals were affected in 2020, which has remained above 160,000 for the last 5 years. The total national health insurance cost was approximately 48.7 billion KRW in 2020 and has shown a continued increase over the last 5 years. This
Clinical Practice Guideline of Korean Medicine for carpal tunnel syndrome has been developed to answer questions often posed by doctors of Korean Medicine dealing with carpal tunnel syndrome and provide practical guidance in clinical application. We expect that the increasing distribution and use of this guideline in clinical sites would contribute to enhancing the therapeutic effect.
With the third Korean Medicine Development Plan (2016-2020), 30 different Clinical Practice Guidelines of Korean Medicines have been developed, and efforts to standardize the Korean medicine service have been initiated. The fourth Korean Medicine Development Plan (2021-2025) is centered around “the improvement of Korean medicine service system” as the key point and highlights “Improvement of reliability through development of the Clinical Practice Guideline of Korean Medicine” and “Standardization of Korean medicine service through expansion of the Clinical Practice Guideline of Korean Medicine.” These plans strengthen the evidence of Korean medicine through the development and distribution of the Clinical Practice Guideline of Korean Medicines, thereby expanding the national
health insurance coverage of Korean medicine services and increasing accessibility for the public. Moreover, the plans reflect the government’s Korean medicine development policy to promote the Korean medicine industry and improve its global competitiveness.
“The innovative technology development program for Korean medicine,” a national R&D initiative in Korean medicine started by the Ministry of Health and Welfare in 2020, supports the development of the Clinical Practice Guideline of Korean Medicine as part of the guideline development project. It aims to develop 51 new Clinical Practice Guidelines of Korean Medicine and actualize and im-
prove 25 of them in the next 10 years.
This Clinical Practice Guideline of Korean Medicine for carpal tunnel syndrome has been developed as part of the “ Development of Clinical Practice Guideline of Korean Medicine and Korean Medicine clinical pathway for carpal tunnel syndrome” (project number: HF20C0201), which is a project of the Innovative Technology Development Group for Korean medicine under ‘the Innovative Technology Development Program for Korean Medicine” in the Ministry of Health and Welfare (research period: 10-26-2020 to 04-30-2022).
Outline of carpal tunnel syndrome
Carpal tunnel syndrome (G56.0 carpal tunnel syndrome; KCD-8 standard, 8C10.0 carpal tunnel syndrome; ICD-11 standard) is a peripheral neuropathy of the median nerve entrapment caused by the thickening of the transverse carpal ligament. Its occurrence in females is approximately five times higher than that in males, and the incidence rate is high in the 40-74 years age group. The main symptoms are pain, abnormal sensation, and numbness around the region of the median nerve distribution. These symptoms increase in severity, especially during the night, as the wrist tends to bend toward the direction of flexion during sleep and leans toward the affected side, putting more pressure on the lesion. If carpal tunnel syndrome is left untreated and unattended, the thenar muscles, especially the abductor pollicis brevis, may degenerate or give rise to muscle weakness.
The carpal bones around the wrist joint form a 凹-shaped surface. The transverse carpal ligament covers the upper part of this 凹-shaped surface. The space between the transverse carpal ligament and carpal bones is called the carpal tunnel. Nine flexor tendons, including the flexor carpi radialis tendon, flexor pollicis longus tendon, flexor digitorum superficialis tendon, and median nerve, travel across the carpal tunnel. For various reasons, if the interior space of the carpal tunnel decreases or the volume of other compartments in the carpal tunnel increases, the pressure on the tissues inside the carpal tunnel increases. This can increase the pressure load on the median nerve and lead to carpal tunnel syndrome. Such an increase in tissue pressure decreases blood supply to the median nerve and causes ischemia of the nerve fibers. If it continues chronically, it can even lead to degeneration of nerve fibers.
The cause of carpal tunnel syndrome is unclear, but excessive use of the wrist and wrist trauma are the main contributing factors. Some activities that can lead to carpal tunnel syndrome include washing dishes, driving, mopping, knitting, typing, and painting. Distal radius fracture malunion, hand burn, infections and edema, tumor, radial artery latency, carpal bone fracture, or dislocations from trauma can also cause carpal tunnel syndrome. Moreover, systemic complications such as pregnancy, obesity, hemodialysis, and rheumatoid arthritis can lead to carpal tunnel syndrome.
