Carpal Tunnel Surgery Relieves More Symptoms Than Splinting, According To Review

Patients have significantly less pain, tingling, numbness and muscle weakness at three months and a year after surgery, compared to those who choose non-surgical treatment.

“The results suggest that surgical treatment is probably better than splinting, but it is unclear whether it is better than steroid injection,” said lead author Renato Verdugo, M.D., of the University of Chile in Santiago.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Last year, a Cochrane review concluded that injected corticosteroids could provide at least a month of relief to people with severe carpal tunnel syndrome.

In the updated review, Verdugo and colleagues examined four new studies involving 317 participants with carpal tunnel syndrome. They found that patients who underwent surgery rarely had to return for a second surgery, while those who first tried medication or splinting often turned to surgery later.

Irritation or compression of the nerve that runs through a tunnel of bone, ligament and tendon in the wrist can cause carpal tunnel syndrome. There are a variety of ways to diagnose the condition, including tests of muscle weakness and nerve responses.

Most patients have non-surgical treatment, but the Cochrane researchers note, “a range of treatment is offered varying widely around the world, within individual countries and even hospitals.”

One of the studies included information on surgery’s side effects, from painful scars, infection, stiffness and discomfort in the wrist. More than half of the surgical and non-surgical patients in the study reported having at least one side effect of their treatment.

Still, other researchers suggest that a “watch and wait” approach to treating carpal tunnel syndrome might be order. After following carpal tunnel patients for two years, rehabilitative medicine specialist Fernando Ortiz-Corredor and colleagues at the National University of Columbia (in Bogota) found that symptoms in two-thirds of patients stayed the same or even improved over time.

Given these data, “a conservative treatment may be all that is needed in a selection of patients with this disorder,” Ortiz-Corredor said.

Reference: RJ Verdugo et al. Surgical versus non-surgical treatment for carpal tunnel syndrome. The Cochrane Database of Systematic Reviews 2008, Issue 4.