The Effectiveness of Surgical and Post-Surgical Interventions for Carpal Tunnel Syndrome–A Systematic Review

• Published in: Archives of physical medicine and rehabilitation
• Main Authors: Huisstede, Bionka MA., PhD, van den Brink, Janneke, PT, MSc, Randsdorp, Manon S., MD, Geelen, Sven JG., BSc, Koes, Bart W., PhD
• Format: Journal Article
• Language: English
• Published: 2017
• Subjects: Physical Medicine and Rehabilitation; RR; Carpal tunnel syndrome; Treatment outcome; RCT; CTS; OR; CI; VAS; odds ratio; SMD; visual analog scale; weighted mean differences; relative risk; randomized controlled trial; WMD; Review [publication type]; MD; Orthopaedic and plastic surgery; complaints of the arm, neck and/or shoulder; confidence interval; mean difference; Rehabilitation; CANS; standardized mean differences
• ISSN: 0003-9993
• DOI: 10.1016/j.apmr.2017.04.024

Abstract Objective To present an evidence-based overview of the effectiveness of surgical and postsurgical interventions for 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) up to April 8th 2016. Data Selection and Extraction Two reviewers independently selected the studies, extracted the data, and assessed the methodological quality. Data Synthesis and Results A best-evidence synthesis was performed to summarize the results. Four systematic reviews and 33 RCTs were included. Surgery versus non-surgical interventions, timing of surgery, various surgical techniques and post-operative interventions were studied. Corticosteroid injection was more effective than surgery (strong evidence, short-term). Surgery was more effective than splinting or anti-inflammatory drugs plus handtherapy (moderate evidence, mid- and longterm). Manual therapy was more effective than surgical treatment (moderate evidence, short and midterm). Within surgery, corticosteroid irrigation of the median nerve before skin closure as additive to CTS-release or the direct vision plus tunnelling technique were more effective than standard open CTS-release (moderate evidence, short term). Furthermore, short- was more effective than long- bulky dressing and a sensory retraining program was more effective than no program after surgery (moderate evidence, shortterm). For all other interventions only conflicting, limited, or no evidence was found. Conclusions Surgical treatment seems to be more effective than splinting, anti-inflammatory drugs plus hand therapy the in short, mid and/or long term to treat CTS. Although there is strong evidence that a local corticosteroid injection is more effective than surgery in shortterm and moderate evidence that manual therapy is more effective than surgery in short and midterm. There is no unequivocal evidence that suggests one surgical treatment is more effective than the other. Postsurgical, a short- favored a long-duration bulky dressing and a sensory retraining program seems to be more effective than no program in shortterm. More research regarding the optimal timing of surgery for CTS is needed.