Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomised parallel-group trial.
BACKGROUND
A previous randomised controlled trial reported greater efficacy of surgery than of splinting for patients with carpal tunnel syndrome. Our aim was to compare surgical versus multi-modality, non-surgical treatment for patients with carpal tunnel syndrome without denervation. We hypothesised that surgery would result in improved functional and symptom outcomes.


METHODS
In this parallel-group randomised controlled trial, we randomly assigned 116 patients from eight academic and private practice centres, using computer-generated random allocation stratified by site, to carpal tunnel surgery (n=57) or to a well-defined, non-surgical treatment (including hand therapy and ultrasound; n=59). The primary outcome was hand function measured by the Carpal Tunnel Syndrome Assessment Questionnaire (CTSAQ) at 12 months assessed by research personnel unaware of group assignment. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00032227.


RESULTS
44 (77%) patients assigned to surgery underwent surgery. At 12 months, 101 (87%) completed follow-up and were analysed (49 of 57 assigned to surgery and 52 of 59 assigned to non-surgical treatment). Analyses showed a significant 12-month adjusted advantage for surgery in function (CTSAQ function score: Delta -0.40, 95% CI 0.11-0.70, p=0.0081) and symptoms (CTSAQ symptom score: 0.34, 0.02-0.65, p=0.0357). There were no clinically important adverse events and no surgical complications.


CONCLUSIONS
Symptoms in both groups improved, but surgical treatment led to better outcome than did non-surgical treatment. However, the clinical relevance of this difference was modest. Overall, our study confirms that surgery is useful for patients with carpal tunnel syndrome without denervation.


BACKGROUND
NIH/NIAMS 5P60AR048093 and the Intramural Research Program of the NIH Clinical Center.
Jarvik
Jeffrey G
JG
Department of Radiology, School of Medicine, University of Washington, Seattle, WA, USA. jarviks@comcast.net
Comstock
Bryan A
BA
Kliot
Michel
M
Turner
Judith A
JA
Chan
Leighton
L
Heagerty
Patrick J
PJ
Hollingworth
William
W
Kerrigan
Carolyn L
CL
Deyo
Richard A
RA
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001182:Arthroscopy; D002349:Carpal Tunnel Syndrome / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D019299:Decompression, Surgical; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D013165:Splints; D016896:Treatment Outcome; D014464:Ultrasonic Therapy
D000894:Anti-Inflammatory Agents, Non-Steroidal