Surgical versus non-surgical treatment for carpal tunnel syndrome

Verdugo RJ, Salinas RA, Castillo JL, Cea JG

Published Online:

October 8, 2008

Carpal tunnel syndrome is caused by compression of the median nerve which goes through the carpal tunnel in the wrist. It causes tingling, numbness and pain, mostly in the hand. Treatment is controversial. This review aimed to compare surgical decompression with non-surgical treatments such as splinting or corticosteroid injections. Four trials were found and included, while three are awaiting assessment. The results suggest that surgical treatment is probably better than splinting but it is unclear whether it is better than steroid injection. Further research is needed for those with mild symptoms.

Abstract (click to read)

Background:

Carpal tunnel syndrome results from entrapment of the median nerve in the wrist. Common symptoms are tingling, numbness, and pain in the hand that may radiate to the forearm or shoulder. Most symptomatic cases are treated non-surgically.

Objectives:

The objective is to compare the efficacy of surgical treatment of carpal tunnel syndrome with non-surgical treatment.

Search strategy:

We searched the Cochrane Neuromuscular Disease Group Trials Register (January 2008), MEDLINE (January 1966 to January 2008), EMBASE (January 1980 to January 2008) and LILACS (January 1982 to January 2008). We checked bibliographies in papers and contacted authors for information about other published or unpublished studies.

Selection criteria:

We included all randomised and quasi-randomised controlled trials comparing any surgical and any non-surgical therapies.

Data collection and analysis:

Two authors independently assessed the eligibility of the trials.

Main results:

In this update we found four randomised controlled trials involving 317 participants in total. Three of them including 295 participants, 148 allocated to surgery and 147 to non-surgical treatment reported information on our primary outcome (improvement at three months of follow-up). The pooled estimate favoured surgery (RR 1.23, 95% CI 1.04 to 1.46). Two trials including 245 participants described outcome at six month follow-up, also favouring surgery (RR 1.19, 95% CI 1.02 to 1.39).

Two trials reported clinical improvement at one year follow-up. They included 198 patients favouring surgery (RR 1.27, 95% CI 1.05 to 1.53). The only trial describing changes in neurophysiological parameters in both groups also favoured surgery (RR 1.44, 95% CI 1.05 to 1.97). Two trials described need for surgery during follow-up, including 198 patients. The pooled estimate for this outcome indicates that 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). Complications of surgery and medical treatment were described by two trials with 226 participants. Although the incidence of complications was high in both groups, they were significantly more common in the surgical arm (RR 1.38, 95% CI 1.08 to 1.76).

Authors' conclusions:

Surgical treatment of carpal tunnel syndrome relieves symptoms significantly better than splinting. Further research is needed to discover whether this conclusion applies to people with mild symptoms and whether surgical treatment is better than steroid injection.

This record should be cited as:

Verdugo RJ, Salinas RA, Castillo JL, Cea JG. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD001552. DOI: 10.1002/14651858.CD001552.pub2

Assessed as up to date:

January 24, 2008

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Primary Review Group:

Neuromuscular Disease Group

Health topics:

Neurology > Peripheral neuropathy > Carpal tunnel syndrome

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Surgical versus non-surgical treatment for carpal tunnel syndrome

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