Article

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.
CI - Copyright 2010 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS