Surgical versus non-surgical treatment for carpal tunnel syndrome.
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.


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


METHODS
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 We checked bibliographies in papers and contacted authors for information about other published or unpublished studies.


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


METHODS
Two authors independently assessed the eligibility of the trials.


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).


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.
Department of Neurology, Faculty of Medicine, Universidad de Chile, Santiago, Region Metropolitana of Santiago, Chile. rverdugo@med.uchile.cl
Renato J
RJ
Verdugo
Rodrigo A
RA
Salinas
José L
JL
Castillo
José G
JG
Cea
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002349:Carpal Tunnel Syndrome / Q000601:surgery* / Q000628:therapy; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013165:Splints
D000305:Adrenal Cortex Hormones