Intervention Review

Surgical versus non-surgical treatment for carpal tunnel syndrome

  1. Renato J Verdugo1,*,
  2. Rodrigo A Salinas2,
  3. José L Castillo3,
  4. José G Cea3

Editorial Group: Cochrane Neuromuscular Disease Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 23 JAN 2008

DOI: 10.1002/14651858.CD001552.pub2


How to Cite

Verdugo RJ, Salinas RA, Castillo JL, Cea JG. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD001552. DOI: 10.1002/14651858.CD001552.pub2.

Author Information

  1. 1

    Universidad de Chile, Department of Neurology, Faculty of Medicine, Santiago, Region Metropolitana of Santiago, Chile

  2. 2

    Ministry of Health, Institute of Public Health of Chile, Santiago, Chile

  3. 3

    University of Chile, Department of Neurology, Santiago, Providencia, Chile

*Renato J Verdugo, Department of Neurology, Faculty of Medicine, Universidad de Chile, Santiago, Region Metropolitana of Santiago, Chile. rverdugo@med.uchile.cl.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 8 OCT 2008

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Carpal tunnel syndrome results from entrapment of the median nerve in the wrist. Common symptoms are tingling, numbness, and pain in the hand that may radiate to the forearm or shoulder. Most symptomatic cases are treated non-surgically.

Objectives

The objective is to compare the efficacy of surgical treatment of carpal tunnel syndrome with non-surgical treatment.

Search methods

We searched the Cochrane Neuromuscular Disease Group Trials Register (January 2008), MEDLINE (January 1966 to January 2008), EMBASE (January 1980 to January 2008) and LILACS (January 1982 to January 2008). We checked bibliographies in papers and contacted authors for information about other published or unpublished studies.

Selection criteria

We included all randomised and quasi-randomised controlled trials comparing any surgical and any non-surgical therapies.

Data collection and analysis

Two authors independently assessed the eligibility of the trials.

Main results

In this update we found four randomised controlled trials involving 317 participants in total. Three of them including 295 participants, 148 allocated to surgery and 147 to non-surgical treatment reported information on our primary outcome (improvement at three months of follow-up). The pooled estimate favoured surgery (RR 1.23, 95% CI 1.04 to 1.46). Two trials including 245 participants described outcome at six month follow-up, also favouring surgery (RR 1.19, 95% CI 1.02 to 1.39).

Two trials reported clinical improvement at one year follow-up. They included 198 patients favouring surgery (RR 1.27, 95% CI 1.05 to 1.53). The only trial describing changes in neurophysiological parameters in both groups also favoured surgery (RR 1.44, 95% CI 1.05 to 1.97). Two trials described need for surgery during follow-up, including 198 patients. The pooled estimate for this outcome indicates that a significant proportion of people treated medically will require surgery while the risk of re-operation in surgically treated people is low (RR 0.04 favouring surgery, 95% CI 0.01 to 0.17). Complications of surgery and medical treatment were described by two trials with 226 participants. Although the incidence of complications was high in both groups, they were significantly more common in the surgical arm (RR 1.38, 95% CI 1.08 to 1.76).

Authors' conclusions

Surgical treatment of carpal tunnel syndrome relieves symptoms significantly better than splinting. Further research is needed to discover whether this conclusion applies to people with mild symptoms and whether surgical treatment is better than steroid injection.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Surgical versus non-surgical treatment for carpal tunnel syndrome

Carpal tunnel syndrome is caused by compression of the median nerve which goes through the carpal tunnel in the wrist. It causes tingling, numbness and pain, mostly in the hand. Treatment is controversial. This review aimed to compare surgical decompression with non-surgical treatments such as splinting or corticosteroid injections. Four trials were found and included, while three are awaiting assessment. The results suggest that surgical treatment is probably better than splinting but it is unclear whether it is better than steroid injection. Further research is needed for those with mild symptoms.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

腕隧道症候群的手術及非手術治療之比較

腕隧道症候群是因為正中神經於手腕受壓迫造成。常見的症狀是手的刺痛,麻木,和疼痛,痛感可牽引放射到前臂或肩膀上。大多數情況下患者接受非手術的治療。

目標

本研究的目標在比較手術或非手術治療腕隧道症候群的效果。

搜尋策略

我們搜查了考科藍神經肌肉疾病試驗紀錄(2008年1月) ,MEDLINE(1966年1月至2008年1月) ,EMBASE(1980年1月至2008年1月)和LILACS(1982年1月至2008年1月) 。我們也查詢了文獻資料並且和研究作者聯繫,取得他們已發佈或其他未發表的研究報告的資訊。

選擇標準

我們蒐集了所有隨機和準隨機對照試驗,比較任何手術或任何非手術療法的效果。

資料收集與分析

兩位作者獨立評估試驗的合適性

主要結論

在這次更新版本的調查中,我們發現4個隨機對照試驗,共317名參與者。其中的3個試驗共295名參與者中, 148人接受手術,147人接受非手術治療,從中得到報告的主要成果(3個月後追蹤症狀改善) 。匯集資料後得到的結果顯示手術效果較佳(RR 1.23, 95% CI 1.04 to 1.46) 。兩項共包括了245名參與者的試驗,報告了6個月後追蹤的結果,也傾向於手術效果較好(RR 1.19, 95% CI 1.02 to 1.39) 。兩項包括了198人的臨床試驗,報告了一年後追蹤的臨床改善率,也以接受手術的效果較好(RR 1.27, 95% CI 1.05 to 1.53) 。唯一一項評估治療前後神經生理檢查變化的試驗,也傾向手術效果較佳(RR 1.44, 95% CI 1.05 to 1.97) 。包括198例的兩個試驗提到後續追蹤需要手術的人數。匯集資料後得到的結果顯示,有相當比例的病人在接受藥物治療後仍需要接受手術治療,而一開始接受手術治療的病人需要接受再手術的比率相當低(0.04 傾向手術治療, 95% CI 0.01 to 0.17) 。包含226人的兩個試驗提到外科治療及藥物治療的併發症。雖然兩組併發症的發生率皆高,但仍明顯較常見於接受手術的病人(RR 1.38, 95% CI 1.08 to 1.76) 。

作者結論

手術治療腕隧道症候群的效果明顯優於腕部夾板治療。本項結論是否適用於症狀輕微的病人,或是手術治療是否優於類固醇注射,則需進一步的研究。

翻譯人

本摘要由新光醫院鍾禎智翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

腕隧道症候群是因正中神經經過腕隧道時的壓迫引起。造成手的刺痛,麻木和疼痛,。治療方式有許多爭議。本篇回顧性調查之目的在比較手術及非手術治療,如腕部夾板或類固醇注射的效果。其中蒐集了4個試驗,另外有3個試驗仍在接受評估中。結果顯示手術治療可能優於腕部夾板,但是否優於類固醇注射目前仍不清楚。對於症狀輕微患者的治療也須更進一步的研究。