Carpal tunnel syndrome. Part II: effectiveness of surgical treatments--a systematic review.
OBJECTIVE
To present an evidence-based overview of the effectiveness of surgical and postsurgical interventions to treat carpal tunnel syndrome (CTS).


METHODS
The Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro were searched for relevant systematic reviews and randomized controlled trials (RCTs).


METHODS
Two reviewers independently applied the inclusion criteria to select potential studies.


METHODS
Two reviewers independently extracted the data and assessed the methodologic quality.


RESULTS
A best-evidence synthesis was performed to summarize the results of the included studies. Two reviews and 25 RCTs were included. Moderate evidence was found in favor of surgical treatment compared with splinting or anti-inflammatory drugs plus hand therapy in the midterm and long term, and for the effectiveness of corticosteroid irrigation of the median nerve before skin closure as additive to carpal tunnel release in the short term. Limited evidence was found in favor of a double-incision technique compared with the standard incision technique. Also, limited evidence was found in favor of a mini-open technique assisted by a Knifelight instrument compared with a standard open release at 19 months of follow-up. However, in the short term and at 30 months of follow-up, no significant differences were found between the mini-open technique assisted by a Knifelight instrument compared with a standard open release. Many studies compared different surgical interventions, but no evidence was found in favor of any one of them. No RCTs explored the optimal timing strategy for surgery. No evidence was found for the efficacy of various presurgical or postsurgical treatment programs, including splinting.


CONCLUSIONS
Surgical treatment seems to be more effective than splinting or anti-inflammatory drugs plus hand therapy in the midterm and long term to treat CTS. However, there is no unequivocal evidence that suggests one surgical treatment is more effective than the other. More research is needed to study conservative to surgical treatment in which also should be taken into account the optimal timing of surgery. Future research should also concentrate on optimal presurgical and postsurgical treatment programs.
Huisstede
Bionka M
BM
Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands. b.huisstede@erasmusmc.nl
Randsdorp
Manon S
MS
Coert
J Henk
JH
Glerum
Suzanne
S
van Middelkoop
Marienke
M
Koes
Bart W
BW
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002349:Carpal Tunnel Syndrome / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D011182:Postoperative Care / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D013165:Splints
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents