Clinical Question: Are nonsurgical approaches to the treatment of patients with carpal tunnel syndrome effective?

Setting: Various (meta-analysis)

Study Design: Systematic review

Synopsis: Investigators systematically reviewed English-language, randomized controlled trials of nonsurgical treatments for patients with carpal tunnel syndrome. They did an exhaustive search of the literature, including MEDLINE, EMBASE, the Cochrane Library, and the registry of controlled trials. They also handsearched references from previously retrieved articles and communicated with authors to obtain unpublished material. Each author assessed the quality of the studies using the PEDro (Physiotherapy Evidence Database) scale, which provides a total score of 10 possible points. Any disagreements were resolved by consensus. Studies had to have a score of at least 3 to be included. In the end, two systematic reviews, 16 randomized controlled trials, and one quasi-experimental study met the requirements.

A fairly high rate of spontaneous resolution was found; nearly 50 percent of patients who were treated with placebo improved. Local steroid injection significantly improved symptoms, but 50 percent of patients had surgery within one year. Oral steroid therapy provided short-term improvement, but no long-term data were available. The following treatment modalities had limited data about their effectiveness (small studies, poor design, mixed or conflicting results): laser-acupuncture, exercises, ultrasonography, splinting, and yoga. The authors were unable to find support for the use of nonsteroidal anti-inflammatory drugs, chiropractic manipulation, pyridoxine, diuretics, or magnets.

Bottom Line: In this systematic review, nonsurgical treatments of carpal tunnel syndrome using injected or oral steroids provided temporary relief. Spontaneous resolution is more common than one might think: nearly 50 percent of patients receiving placebos will improve. Long-term data on most treatments are lacking. In the few studies with long-term follow-up, as many as 50 percent of patients underwent surgery during the first year after enrollment. (Level of Evidence: 1a–)