Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? a systematic review

Abstract

BackgroundCarpal tunnel syndrome is a common disorder in hand surgery practice. Both surgical and conservative interventions are utilized for the carpal tunnel syndrome. Although certain indications would specifically indicate the need for surgery, there is a spectrum of patients for whom either treatment option might be selected. The purpose of this systematic review was to compare the efficacy of surgical treatment of carpal tunnel syndrome with conservative treatmentMethodsWe included all controlled trials written in English, attempting to compare any surgical interventions with any conservative therapies. We searched Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2010), MEDLINE (1980 to June 2010), EMBASE (1980 to June 2010), PEDro (searched in June 2010), international guidelines, computer searches based on key words and reference lists of articles. Two reviewers performed study selection, assessment of methodological quality and data extraction independently of each other. Weighted mean differences and 95% confidence intervals for patient self-reported functional and symptom questionnaires were calculated. Relative risk (RR) and 95% confidence intervals for electrophysiological studies and complication were also calculated.ResultsWe assessed seven studies in this review including 5 RCTs and 2 controlled trials. The methodological quality of the trials ranged from moderate to high. The weighted mean difference demonstrated a larger treatment benefit for surgical intervention compared to non surgical intervention at six months for functional status 0.35( 95% CI 0.22, 0.47) and symptom severity 0.43 (95% CI 0.29, 0.57). There were no statistically significant difference between the intervention options at 3 months but there was a benefit in favor of surgery in terms of function and symptom relief at 12 months ( 0.35, 95% CI 0.15, 0.55 and 0.37, 95% CI 0.19 to 0.56). The RR for secondary outcomes of normal nerve conduction studies was 2.3 (95% CI 1.2, 4.4), while RR was 2.03 (95% CI 1.28 to 3.22) for complication, both favoring surgery.ConclusionBoth surgical and conservative interventions had treatment benefit in carpal tunnel syndrome. Surgical treatment has a superior benefit, in symptoms and function, at six and twelve months. Patient underwent surgical release were two times more likely to have normal nerve conduction studies but also had complication and side effects as well. Given the treatment differential and potential for adverse effects and that conservative interventions benefitted a substantial proportion of patients, current practice of a trial of conservative management with surgical release for severe or persistent symptoms is supported by evidence.

Comparison of the Efficacy of Carpal Tunnel Release vs. Local Steroid Injection in the Management of Mild to Moderate Carpal Tunnel Syndrome: A Clinical Trial

“…Even so, the complication and side effects of CTR were more considerable as well. Altogether, they concluded that since conservative management is effective in relieving symptoms in a certain proportion of cases and can avoid the complications of the surgery, it remains a justified first line treatment (8).…”

“…Conservative options for CTS treatment include splinting, nonsteroidal anti-inflammatory drugs (NSAIDs), local steroid injection (LSI), and systemic steroids. Surgical treatment of CTS includes surgical decompression through carpal tunnel release (CTR), which is usually applied for patients with progressive and persistent signs and symptoms, especially the thenar atrophy (8).…”

Pulsed Magnetic Field Versus Surgery in Carpal Tunnel Syndrome: A Randomized, Placebo Controlled Double Blind Study

“…In this study, high levels of complications were observed in both groups (57% in group allocated to surgery, 52% in non-surgical group). (Shi and MacDermid, 2011) The authors noted large variation as some studies reported all complications while others only reported clinically important adverse events. Overall pooled results indicated that non-surgical treatment for CTS was associated with fewer complications than surgery.…”

“…In their discussion of the results, the authors concluded that given the treatment differential and potential for adverse effects and that conservative interventions benefitted a substantial proportion of patients, current practice of a trial of conservative management with surgical release for severe or persistent symptoms is supported by evidence. (Shi and MacDermid, 2011) In the current study we used BCTQ to evaluate the patient progress regarding neurogenic symptoms and functional disability. Manyauthors consider BCTQ reliable and valid methods in dealing with CTS.…”

Ibuprofen as a Treatment for Work-Related Musculoskeletal Disorders: Effectiveness versus Caveats

“…However, RICE has proved less efective for treatment of pain associated with chronic overuse-MSDs than NSAIDs. Splinting for carpal tunnel syndrome is less efective than surgical release or injections of steroids around the nerve [19][20][21][22][23][24], which are also not always efective [19][20][21][22][23][24].…”