CLINICAL QUESTION

Is surgery safe and effective for the treatment of carpal tunnel syndrome compared with nonsurgical treatment?

EVIDENCE-BASED ANSWER

Surgery for carpal tunnel syndrome probably results in some clinical improvement compared with splinting in the long term (more than 3 months), but it does not appear to lead to clinically significant improvement in symptoms or hand function. Similarly, surgery does not appear to result in clinically meaningful improvement compared with corticosteroid injection in the long term. It is not clear whether there are any differences in adverse effects between surgical and nonsurgical interventions.¹ (Strength of Recommendation: B, inconsistent or limited-quality patient-oriented evidence.)

PRACTICE POINTERS

Carpal tunnel syndrome is a compression neuropathy of the median nerve at the wrist.¹ Common symptoms are numbness, tingling, and pain within the median nerve distribution. In more severe cases, skin sensation can be permanently diminished, and axonal injury results in atrophy of the thenar muscles.^1,2 Carpal tunnel syndrome is a clinical diagnosis, but there are no universally accepted diagnostic criteria or treatment guidelines.^1,3 Management is often guided by disease severity and symptom duration. Those with severe symptoms or objective findings of thenar atrophy or positive electrodiagnostic changes are often referred for surgical evaluation. Those with mild or early symptoms are often treated with nonsurgical interventions, such as splinting or corticosteroid injection. The authors of this Cochrane review evaluated the outcomes of various nonsurgical treatment modalities vs. various surgical therapies.