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Evidence summaries

Surgical Vs. Non-Surgical Treatment for Carpal Tunnel Syndrome

Surgery appears to be more effective than splinting for carpal tunnel syndrome. Whether surgical treatment is better than steroid injection remains unclear. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 4 studies comparing surgery to either splinting or a steroid injection, with a total of 317 subjects. The pooled estimate favoured surgery for the primary outcome, improvement at three months of follow-up (RR 1.23, 95% CI 1.04 to 1.46; 3 trials, n=295). The outcome was favourable for surgery also at six months (RR 1.19, 95% CI 1.02 to 1.39; 2 trials, n=245) and at one year (RR 1.27, 95% CI 1.05 to 1.53; 2 trials, n= 198). Neurophysiological parameters also favoured surgery (RR 1.44, 95% CI 1.05 to 1.97; 1 trial, n=50). A significant proportion of people treated medically will require surgery while the risk of re-operation in surgically treated people is low (RR 0.04 favouring surgery, 95% CI 0.01 to 0.17; 2 trials, n=198). Complications were significantly more common in the surgical arm (RR 1.38, 95% CI 1.08 to 1.76; 2 trials, n=226).

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in participants, interventions and outcomes).

    References

    • Verdugo RJ, Salinas RA, Castillo JL, Cea JG. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev 2008;(4):CD001552. [PubMed]

Primary/Secondary Keywords