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Surgical versus non-surgical treatment for carpal tunnel syndrome

  • Review
  • Intervention


  • RJ Verdugo,

  • RS Salinas,

  • J Castillo,

  • JG Cea

Dr Renato Verdugo, Departmento de Ciencias Neurologicas, Universidad de Chile, Santiago, CHILE.



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. Surgical treatment is widely preferred to non-surgical or conservative therapies for people who have overt symptoms, while mild cases are usually not treated.


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

Search strategy

We searched the Cochrane Neuromuscular Disease Group trials register and MEDLINE, EMBASE and LILACS (to October 2002). We checked bibliographies in papers and contacted authors for information about other published or unpublished studies.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 reviewers independently assessed the eligibility of the trials.

Main results

We found two randomised controlled trials involving 198 participants in total. The first trial included 22 participants, 11 allocated to surgery and 11 to splinting for one month. The trial was not blinded nor was it clear if allocation was properly concealed. In the second trial, 87 participants were allocated to surgery and 89 to splinting for at least six weeks. The trial was not blinded but allocation concealment was adequate. The second trial considered our primary outcome measure, relevant clinical improvement at three months. Sixty-two people out of 87 allocated to surgery (71%) qualified for treatment success. Forty-six people out of 89 allocated to splinting (51.6%) qualified for treatment success. The confidence interval favoured the surgical group (relative risk 1.38 95% confidence interval 1.08 to 1.75). We were able to pool data from both trials for two secondary outcomes. For clinical improvement at one year of follow-up, the pooled estimate favoured surgery (relative risk 1.27, 95% confidence intervals 1.05 to 1.53). For need for surgery during follow-up, the pooled estimate indicates that a significant proportion of people treated medically will require surgery while the risk of re-operation in surgically treated people is low (relative risk 0.04 in favour of surgery, 95% confidence intervals 0.01 to 0.17).

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.

Plain language summary

Plain language summary

Surgical treatment of carpal tunnel syndrome is probably better than splinting

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. Only two trials were found. The results suggest that surgical treatment is better than splinting. Further research is needed for those with mild symptoms.