Surgical Procedures Versus Nonoperative Treatments
Strong evidence supports that surgical treatment of carpal tunnel syndrome should have a greater treatment benefit at 6 and 12 months as compared to splinting, NSAIDs/therapy, and a single steroid injection.
STRONG RECOMMENDATION Rationale
Four high quality (Gerritsen 2002, Hui 2005, Ismatullah 2013, and Jarvik 2009) and 3 moderate quality (Andreu 2013, Ly 2005, and Ly-Pen 2012) studies compared the effectiveness of surgical treatment to non-operative treatment for the relief of CTS symptoms. All three studies showed that surgery was superior for the relief of daytime and nocturnal paresthesias and return of grip strength. Of these, one high quality (Gerritson 2002) and one moderate quality study (Andreu 2013) examined the long term outcomes for surgery versus conservative treatment and found better results with surgery
- Andreu,J.L.; Ly-Pen,D.; Millan,I.; de,Blas G.; Sanchez-Olaso,A. Local injection versus surgery in carpal tunnel syndrome: Neurophysiologic outcomes of a randomized clinical trial. Clin Neurophysiol.; 2013/11/23: 0
- Gerritsen,A.A.; de Vet,H.C.; Scholten,R.J.; Bertelsmann,F.W.; de Krom,M.C.; Bouter,L.M. Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomized controlled trial. ; 2002/9/11: 10
- Hui,A.C.; Wong,S.; Leung,C.H.; Tong,P.; Mok,V.; Poon,D.; Li-Tsang,C.W.; Wong,L.K.; Boet,R. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. ; 2005/6/28: 12
- Ismatullah,I. Local steroid injection or carpal tunnel release for carpal tunnel syndrome - Which is more effective?. Journal of Postgraduate Medical Institute; 2013: 2
- Jarvik,J.G.; Comstock,B.A.; Kliot,M.; Turner,J.A.; Chan,L.; Heagerty,P.J.; Hollingworth,W.; Kerrigan,C.L.; Deyo,R.A. Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomised parallel-group trial. ; 2009/9/26: 9695
- Ly,Pen D.; Andréu,J.L.; Blas,G.; Sánchez,Olaso A.; Millán,I. Surgical decompression versus local steroid injection in carpal tunnel syndrome: a one-year, prospective, randomized, open, controlled clinical trial. Arthritis Rheum.; 2005: 0
- Ly-Pen,D.; Andreu,J.L.; Millan,I.; de,Blas G.; Sanchez-Olaso,A. Comparison of surgical decompression and local steroid injection in the treatment of carpal tunnel syndrome: 2-year clinical results from a randomized trial. Rheumatology (Oxford); 2012/8: 8