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Intervention Review

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Rehabilitation following carpal tunnel release

  1. Susan Peters1,2,*,
  2. Matthew J Page3,
  3. Michel W Coppieters1,
  4. Mark Ross2,4,
  5. Venerina Johnston1

Editorial Group: Cochrane Neuromuscular Group

Published Online: 5 JUN 2013

Assessed as up-to-date: 3 APR 2012

DOI: 10.1002/14651858.CD004158.pub2


How to Cite

Peters S, Page MJ, Coppieters MW, Ross M, Johnston V. Rehabilitation following carpal tunnel release. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD004158. DOI: 10.1002/14651858.CD004158.pub2.

Author Information

  1. 1

    The University of Queensland, Division of Physiotherapy, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia

  2. 2

    Brisbane Hand and Upper Limb Research Institute, Brisbane, Queensland, Australia

  3. 3

    Monash University, School of Public Health & Preventive Medicine, Melbourne, Victoria, Australia

  4. 4

    The University of Queensland, Division of Orthopaedic Surgery, School of Medicine, Brisbane, Queensland, Australia

*Susan Peters, Brisbane Hand and Upper Limb Research Institute, Level 9, 259 Wickham Terrace, Brisbane, Queensland, QLD 4000, Australia. Research@upperlimb.com.

Publication History

  1. Publication Status: New
  2. Published Online: 5 JUN 2013

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This is not the most recent version of the article. View current version (17 FEB 2016)

[Figure 1]
Figure 1. Study flow diagram.
[Figure 2]
Figure 2. Risk of bias summary: review authors' judgements about each risk of bias item for each included study. Key: red = high risk of bias; yellow = unclear risk of bias; green = low risk of bias; blank = not applicable.
[Analysis 1.1]
Analysis 1.1. Comparison 1 Low-level laser versus placebo, Outcome 1 Change in CTS symptoms (night time pain).
[Analysis 1.2]
Analysis 1.2. Comparison 1 Low-level laser versus placebo, Outcome 2 Change in CTS symptoms (palmar pain).
[Analysis 1.3]
Analysis 1.3. Comparison 1 Low-level laser versus placebo, Outcome 3 Change in CTS symptoms (numbness).
[Analysis 1.4]
Analysis 1.4. Comparison 1 Low-level laser versus placebo, Outcome 4 Change in CTS symptoms (paraesthesia).
[Analysis 1.5]
Analysis 1.5. Comparison 1 Low-level laser versus placebo, Outcome 5 Number with CTS clinical signs (Durkan's, Tinel's, Phalen's tests, numbness, paraesthesia, nighttime pain).
[Analysis 1.6]
Analysis 1.6. Comparison 1 Low-level laser versus placebo, Outcome 6 Iatrogenic symptoms (scar pain).
[Analysis 1.7]
Analysis 1.7. Comparison 1 Low-level laser versus placebo, Outcome 7 Iatrogenic symptoms (pillar pain).
[Analysis 1.8]
Analysis 1.8. Comparison 1 Low-level laser versus placebo, Outcome 8 Return to ADL or work (6 months).
[Analysis 1.9]
Analysis 1.9. Comparison 1 Low-level laser versus placebo, Outcome 9 Adverse events (surgery).
[Analysis 2.1]
Analysis 2.1. Comparison 2 Immobilisation (wrist splint) versus mobilisation (bulky dressing), Outcome 1 Change in CTS symptoms (patient report of being symptom free).
[Analysis 2.2]
Analysis 2.2. Comparison 2 Immobilisation (wrist splint) versus mobilisation (bulky dressing), Outcome 2 Long-term change in CTS symptoms (number of patients who reported being 'improved' or 'cured').
[Analysis 2.3]
Analysis 2.3. Comparison 2 Immobilisation (wrist splint) versus mobilisation (bulky dressing), Outcome 3 Return to normal occupations.
[Analysis 2.4]
Analysis 2.4. Comparison 2 Immobilisation (wrist splint) versus mobilisation (bulky dressing), Outcome 4 Adverse effects.
[Analysis 3.1]
Analysis 3.1. Comparison 3 Immobilisation (plaster of Paris splint) versus bulky dressing and mobilisation, Outcome 1 Long-term improvement in functional ability (BCTQ Functional Status Score).
[Analysis 3.2]
Analysis 3.2. Comparison 3 Immobilisation (plaster of Paris splint) versus bulky dressing and mobilisation, Outcome 2 Short-term improvement in functional ability (BCTQ Functional Status Score).
[Analysis 3.3]
Analysis 3.3. Comparison 3 Immobilisation (plaster of Paris splint) versus bulky dressing and mobilisation, Outcome 3 Change in CTS symptoms (BCTQ Symptom Severity Score).
[Analysis 3.4]
Analysis 3.4. Comparison 3 Immobilisation (plaster of Paris splint) versus bulky dressing and mobilisation, Outcome 4 Change in CTS symptoms (Symptom Intensity Score).
[Analysis 3.5]
Analysis 3.5. Comparison 3 Immobilisation (plaster of Paris splint) versus bulky dressing and mobilisation, Outcome 5 Change score between baseline and 2 weeks (Symptom Intensity Score).
[Analysis 3.6]
Analysis 3.6. Comparison 3 Immobilisation (plaster of Paris splint) versus bulky dressing and mobilisation, Outcome 6 Change in impairment (sensibility measured using static two-point discrimination).
[Analysis 3.7]
Analysis 3.7. Comparison 3 Immobilisation (plaster of Paris splint) versus bulky dressing and mobilisation, Outcome 7 Change score between baseline and 2 weeks (Discrimination Index).
[Analysis 3.8]
Analysis 3.8. Comparison 3 Immobilisation (plaster of Paris splint) versus bulky dressing and mobilisation, Outcome 8 Iatrogenic Symptoms.
[Analysis 3.9]
Analysis 3.9. Comparison 3 Immobilisation (plaster of Paris splint) versus bulky dressing and mobilisation, Outcome 9 Adverse event.
[Analysis 4.1]
Analysis 4.1. Comparison 4 Specialised home elevation device versus standard sling, Outcome 1 Short-term improvement in CTS symptoms (VAS pain 0-10) (3 months or less).
[Analysis 4.2]
Analysis 4.2. Comparison 4 Specialised home elevation device versus standard sling, Outcome 2 Iatrogenic symptoms (swelling).
[Analysis 5.1]
Analysis 5.1. Comparison 5 Controlled cold therapy versus ice therapy, Outcome 1 Short-term improvement in CTS symptoms (VAS pain 0-10) (3 months or less).
[Analysis 5.2]
Analysis 5.2. Comparison 5 Controlled cold therapy versus ice therapy, Outcome 2 Iatrogenic symptoms (swelling).
[Analysis 6.1]
Analysis 6.1. Comparison 6 Bulky dressing plus splint versus light dressing, Outcome 1 Iatrogenic symptom (scar pain).
[Analysis 6.2]
Analysis 6.2. Comparison 6 Bulky dressing plus splint versus light dressing, Outcome 2 Adverse event (median nerve, digital nerve, vascular, tendon complications, delayed wound healing).
[Analysis 7.1]
Analysis 7.1. Comparison 7 Contrast bath plus exercise versus contrast bath, Outcome 1 Iatrogenic symptom (swelling).
[Analysis 8.1]
Analysis 8.1. Comparison 8 Contrast bath plus exercises versus exercise, Outcome 1 Iatrogenic symptom (swelling).
[Analysis 9.1]
Analysis 9.1. Comparison 9 Contrast bath versus exercise, Outcome 1 Iatrogenic symptom (swelling).
[Analysis 10.1]
Analysis 10.1. Comparison 10 Arnica versus placebo, Outcome 1 Change in impairment measure (grip strength).
[Analysis 10.2]
Analysis 10.2. Comparison 10 Arnica versus placebo, Outcome 2 Iatrogenic symptom (swelling; % wrist circumference change difference).
[Analysis 11.1]
Analysis 11.1. Comparison 11 High dose arnica oral tablets versus placebo, Outcome 1 Iatrogenic symptoms (number of patients with no clinician-rated bruising).
[Analysis 11.2]
Analysis 11.2. Comparison 11 High dose arnica oral tablets versus placebo, Outcome 2 Adverse effects.
[Analysis 12.1]
Analysis 12.1. Comparison 12 Low dose arnica tablets versus placebo, Outcome 1 Iatrogenic symptoms (number of patients with no clinician-rated bruising).
[Analysis 12.2]
Analysis 12.2. Comparison 12 Low dose arnica tablets versus placebo, Outcome 2 Adverse events.
[Analysis 13.1]
Analysis 13.1. Comparison 13 High dose versus low dose oral arnica tablets, Outcome 1 Iatrogenic symptoms (number of patients with no clinician-rated bruising).
[Analysis 13.2]
Analysis 13.2. Comparison 13 High dose versus low dose oral arnica tablets, Outcome 2 Adverse events.
[Analysis 14.1]
Analysis 14.1. Comparison 14 Multimodal hand therapy versus normal activities/exercise, Outcome 1 Long-term improvement in functional ability (BCTQ Functional Status Score).
[Analysis 14.2]
Analysis 14.2. Comparison 14 Multimodal hand therapy versus normal activities/exercise, Outcome 2 Change in impairment measure (grip strength).
[Analysis 14.3]
Analysis 14.3. Comparison 14 Multimodal hand therapy versus normal activities/exercise, Outcome 3 Change in impairment measure (lateral pinch strength).
[Analysis 14.4]
Analysis 14.4. Comparison 14 Multimodal hand therapy versus normal activities/exercise, Outcome 4 Return to normal occupations.
[Analysis 14.5]
Analysis 14.5. Comparison 14 Multimodal hand therapy versus normal activities/exercise, Outcome 5 Adverse effects.
[Analysis 15.1]
Analysis 15.1. Comparison 15 Desensitisation therapy (as part of multiple interventions) versus no treatment, Outcome 1 Long-term improvement in functional ability (BCTQ Functional Status Score).
[Analysis 15.2]
Analysis 15.2. Comparison 15 Desensitisation therapy (as part of multiple interventions) versus no treatment, Outcome 2 Short-term improvement in functional ability (BCTQ Functional Status Score).
[Analysis 15.3]
Analysis 15.3. Comparison 15 Desensitisation therapy (as part of multiple interventions) versus no treatment, Outcome 3 Change in CTS symptoms (pain or discomfort).
[Analysis 15.4]
Analysis 15.4. Comparison 15 Desensitisation therapy (as part of multiple interventions) versus no treatment, Outcome 4 Change in impairment measure (grip strength).
[Analysis 15.5]
Analysis 15.5. Comparison 15 Desensitisation therapy (as part of multiple interventions) versus no treatment, Outcome 5 Iatrogenic symptoms (scar sensitivity using dolorimetry).
[Analysis 15.6]
Analysis 15.6. Comparison 15 Desensitisation therapy (as part of multiple interventions) versus no treatment, Outcome 6 Adverse events (wound dehiscence).
[Analysis 16.1]
Analysis 16.1. Comparison 16 Short duration dressing versus extended duration dressing, Outcome 1 Short-term improvement in functional ability (BCTQ Functional Status Score).
[Analysis 16.2]
Analysis 16.2. Comparison 16 Short duration dressing versus extended duration dressing, Outcome 2 Change in CTS symptoms (BCTQ Symptom Severity Score).
[Analysis 16.3]
Analysis 16.3. Comparison 16 Short duration dressing versus extended duration dressing, Outcome 3 Change in impairment measure (grip strength).
[Analysis 16.4]
Analysis 16.4. Comparison 16 Short duration dressing versus extended duration dressing, Outcome 4 Change in impairment measure (pinch strength).
[Analysis 16.5]
Analysis 16.5. Comparison 16 Short duration dressing versus extended duration dressing, Outcome 5 Adverse event.