Review article (meta-analysis)
Carpal Tunnel Syndrome. Part II: Effectiveness of Surgical Treatments—A Systematic Review

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Abstract

Huisstede BM, Randsdorp MS, Coert JH, Glerum S, van Middelkoop M, Koes BW. Carpal tunnel syndrome. Part II: effectiveness of surgical treatments—a systematic review.

Objective

To present an evidence-based overview of the effectiveness of surgical and postsurgical interventions to treat carpal tunnel syndrome (CTS).

Data Sources

The Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro were searched for relevant systematic reviews and randomized controlled trials (RCTs).

Study Selection

Two reviewers independently applied the inclusion criteria to select potential studies.

Data Extraction

Two reviewers independently extracted the data and assessed the methodologic quality.

Data Synthesis

A best-evidence synthesis was performed to summarize the results of the included studies. Two reviews and 25 RCTs were included. Moderate evidence was found in favor of surgical treatment compared with splinting or anti-inflammatory drugs plus hand therapy in the midterm and long term, and for the effectiveness of corticosteroid irrigation of the median nerve before skin closure as additive to carpal tunnel release in the short term. Limited evidence was found in favor of a double-incision technique compared with the standard incision technique. Also, limited evidence was found in favor of a mini-open technique assisted by a Knifelight instrument compared with a standard open release at 19 months of follow-up. However, in the short term and at 30 months of follow-up, no significant differences were found between the mini-open technique assisted by a Knifelight instrument compared with a standard open release. Many studies compared different surgical interventions, but no evidence was found in favor of any one of them. No RCTs explored the optimal timing strategy for surgery. No evidence was found for the efficacy of various presurgical or postsurgical treatment programs, including splinting.

Conclusions

Surgical treatment seems to be more effective than splinting or anti-inflammatory drugs plus hand therapy in the midterm and long term to treat CTS. However, there is no unequivocal evidence that suggests one surgical treatment is more effective than the other. More research is needed to study conservative to surgical treatment in which also should be taken into account the optimal timing of surgery. Future research should also concentrate on optimal presurgical and postsurgical treatment programs.

Section snippets

Search Strategy

A search of relevant systematic reviews on CTS was performed in the Cochrane Library. In addition, relevant review publications and RCTs in PubMed, EMBASE, CINAHL, and PEDro were searched (1) for interventions included in the systematic reviews from the date of the search strategy of the review up to January 2010 (ie, recent RCTs) and (2) from the beginning of the database up to January 2010 (ie, additional RCTs).

Keywords related to the disorder such as “carpal tunnel syndrome,” “median nerve

Characteristics of the Included Studies

The initial literature search resulted in the identification of 4 systematic reviews from the Cochrane library and 47 reviews (7 from PubMed, 29 from EMBASE, 11 from CINAHL). Further, we found 750 RCTs (241 from PubMed, 276 from EMBASE, 177 from CINAHL, 56 from PEDro). Finally, after selection based on the content of the titles, abstracts, and full text of the references, 2 Cochrane reviews and 25 RCTs (22 from PubMed, 2 from EMBASE, 1 from PEDro, none from CINAHL) met our inclusion criteria.

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