Effectiveness of surgical versus conservative treatment for carpal tunnel syndrome: A systematic review, meta-analysis and qualitative analysis

Diony Klokkari, Ioannis Mamais, Diony Klokkari, Ioannis Mamais

Abstract

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. Treatment options include physiotherapy, splinting, steroid injections or surgery.

Objective: To compare the effectiveness of surgical versus conservative treatment for CTS for symptom and functional improvement and improvement of neurophysiological parameters.

Methods: Systematic searches of PubMed and EBSCO host were conducted to identify the studies published between 1990 and 2016, comparing any surgical treatment to any conservative treatment. Participants were adults with a diagnosis of CTS, with symptom duration ranging from 8 months to 3 years. A meta-analysis and a qualitative analysis were conducted to summarize the results of the included studies and establish any agreement between the two.

Results: A total of 15 studies were included in the study and 10 were included in the meta-analysis, involving 1787 wrists. The qualitative and quantitative analyses were consistent with the results of both indicating that surgical treatment leads to a greater improvement of symptoms at six months (mean difference: 0.52, 95%CI 0.27 to 0.78) and a greater improvement of neurophysiological parameters [distal motor latency (mean difference: 0.31, 95%CI 0.06 to 0.56), sensory nerve conduction velocity (mean difference: 3.71 m/s, 95%CI 1.94 to 5.49)]. At 3 months and 12 months, the results were not significant in favor of surgery or conservative treatment.

Conclusion: Conservative treatment for CTS should be preferred for mild and short-term CTS. Surgery is more effective than conservative in CTS, and should be considered in persisting symptoms, taking into account the complications, which are more severe after surgery. Further research should focus on the field of manual therapy and compare it to surgical treatment for CTS.

Keywords: Carpal tunnel syndrome; conservative treatment; median nerve entrapment; meta-analysis; surgical treatment; systematic review.

Figures

Fig. 1.
Fig. 1.
Selection of studies for inclusion in the systematic review. *Papers may have been excluded for failing to meet more than one inclusion criteria.
Fig. 2.
Fig. 2.
MD (95%CI) of effect of surgical and conservative treatment on symptom improvement at six months of treatment by pooling data from six studies (n=805).
Fig. 3.
Fig. 3.
MD (95%CI) of effect of surgical and conservative treatment on functional improvement at 3, 6 and 12 months of treatment by pooling data from six studies (n=918).
Fig. 4.
Fig. 4.
MD (95%CI) of effect of surgical and conservative treatment on improvement of DML between 5 and 12 months of treatment by pooling data from four studies (n=337).
Fig. 5.
Fig. 5.
MD (95%CI) of effect of surgical and conservative treatment on improvement of SNCV at six months of treatment by pooling data from three studies (n=174). *Left = results in favor of surgery, Right = results in favor of conservative treatment.
Fig. 6.
Fig. 6.
OR (95%CI) of effect of surgical and conservative treatment on complications reported by pooling data from eight studies (n=759).
Fig. C.1.
Fig. C.1.
Detailed meta-analysis results for symptom improvement if only high quality studies,,, were included.
Fig. C.2.
Fig. C.2.
Detailed meta-analysis results for functional improvement at 6 and 12 months if only high quality studies,, were included.
Fig. C.3.
Fig. C.3.
OR (95%CI) of effect of surgical and conservative treatment on complications reported if only high quality studies,, were included.

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