COMPARISON OF NON-OPERATIVE TREATMENTS

Numerous articles compared various therapies for carpal tunnel against other therapies. Not only were the treatments and their comparisons very heterogeneous, but no long-term follow also up was described either – as such, this recommendation has been downgraded. The majority of the studies did not demonstrate any significant difference between the treatment arms. When comparing corticosteroid injection versus shockwave therapy, the results were equivocal with one study out of four favoring ESWT, another favoring CSI, and two showing no significant difference between the treatment groups. When comparing ESWT with various treatments, three studies showed a slight benefit in ESWT.

Benefits/Harms of Implementation
The above non operative treatments do not show a consistent significant difference from other treatments and add to the time and monetary expense for patients suffering from CTS.

Outcome Importance
As there is limited data with mixed quality of evidence, any particular non-operative treatment cannot be recommended over another non-operative treatment.

Cost Effectiveness/Resource Utilization
None of the non-operative treatments have shown long-term success in the treatment of CTS and therefore, are not considered cost-effective options.

Acceptability
Due to lack of supporting evidence, this guideline is anticipated to be accepted by surgeons, patients, and therapists.

Feasibility
Readily available and feasible to not use these modalities.

Future Research
No long-term follow up studies are available to confirm the lack of effectiveness of these therapies, however, are likely not necessary, given the lack of short-term benefits.