Decompression surgery is the most appropriate treatment for this patient with carpal tunnel syndrome. Patients with this disorder who have active denervation on nerve conduction studies and have muscle weakness and atrophy on clinical examination should undergo decompression surgery to prevent irreversible motor weakness. Uncontrolled pain and sensory symptoms can be another indication for surgery, but in the absence of motor weakness and active denervation, conservative measures to treat pain and control paresthesia should be attempted first.

Symptomatic treatment, such as NSAIDs, gabapentin, and glucocorticoid injections, and conservative treatment, such as nocturnal neutral position wrist splinting and occupational therapy, may be appropriate therapy for patients with mild to moderate carpal tunnel syndrome, but only if they have no evidence of weakness, atrophy, or active motor denervation on nerve conduction studies. Weight reduction also can be helpful in patients with obesity.

Diabetes mellitus can cause (or predispose one to) compressive mononeuropathies, including median neuropathy at the wrist and ulnar neuropathy at the elbow. However, patients with diabetes who experience hand numbness also should be assessed for carpal tunnel syndrome. The criteria for using surgical decompression to treat carpal tunnel syndrome and the expected response to surgery are similar in patients with and without diabetes.