Year: 2025 | Month: February | Volume: 12 | Issue: 2 | Pages: 312-323
DOI: https://doi.org/10.52403/ijrr.20250236
Surgery Versus Conservative Treatment for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis
Made Ayu Devi Pita Loka1, Made Bramantya Karna2, Anak Agung Gde Yuda Asmara2, Stedi Adyana Christian2
1Resident, Department of Orthopaedic and Traumatology, Faculty of Medicine, University of Udayana/Prof. Ngoerah General Hospital, Denpasar, Indonesia.
2Orthopaedic and Traumatology Consultant, Department of Orthopaedic and Traumatology, Faculty of Medicine, University of Udayana/Prof. Ngoerah General Hospital, Denpasar, Indonesia.
Corresponding Author: Made Ayu Devi Pita Loka
ABSTRACT
Introduction: The necessity to establish evidence-based criteria for recommending open release surgery in the management of CTS. While conservative treatments are often the initial approach, a subgroup of patients experiences persistent or severe symptoms despite these interventions. This systematic review and meta-analysis aim to synthesize existing evidence on the indication for open release surgery in CTS.
Materials and Methods: The search methodology encompassed diverse synonyms to guarantee thorough exploration of literature across PubMed, Europe PMC, and Clinicaltrials.gov (as of April 20, 2024). This approach aimed to achieve comprehensive coverage and inclusivity in identifying relevant studies, utilizing terms such as "Carpal tunnel syndrome" or "Median nerve compression" in conjunction with "Open carpal tunnel release" or "Carpal tunnel release," as well as "Non-surgical management," "Conservative treatment," "Splinting," "Steroid injections," "Physical therapy," "NSAIDs," "Acupuncture," and "Alternative therapies." Our primary focus centered on the improvement of patient-reported function and the alleviation of symptoms. To assess function, we utilized the Boston Questionnaire, a validated instrument tailored to measure functional outcomes, while for evaluating symptoms, we employed the Carpal Tunnel Syndrome Assessment Questionnaire, specifically designed to gauge symptom severity.
Results: Our analysis encompassed data extracted from 10 research investigations, comprising a collective sample size of 966 patients, involving a total of 1,028 wrists, with 148 of these representing male subjects. We found that functional outcomes were assessed at various intervals, revealing a SMD of 0.29 [-0.21; 0.80] at 3 months (p < 0.01), -0.44 [-0.74; -0.14] at 6 months (p = 0.02), and -0.28 [-0.55; -0.01] at 12 months (p = 0.17).
Conclusion: Open release surgery is considered when conservative measures fail to provide adequate relief from symptoms of carpal tunnel syndrome or when specific indications suggest that surgery would be more appropriate.
Keywords: Carpal tunnel syndrome, open release, indication, symptoms
[PDF Full Text]