Clinical question
How does carpal tunnel release compare with non-surgical treatment for carpal tunnel syndrome?
Bottom line
At long-term follow-up, surgery probably provides better clinical improvement compared with splinting and manual therapy, but the benefits of surgery in symptoms and hand function seem to be small compared with non-surgical treatment. The decision for a patient to opt for surgery should balance the small benefits and potential risks of surgery.
Patients with severe symptoms, a high preference for clinical improvement and reluctance to adhere to non-surgical options, and who do not consider potential surgical risks and morbidity a burden, may choose surgery.
Alternatively, those who have tolerable symptoms, have not tried non-surgical options and want to avoid surgery-related morbidity can start with non-surgical options and have surgery only if they fail to achieve a satisfactory symptom state with non-surgical options.
Caveat
Whether the risk of adverse effects differs between surgery and non-surgical treatments is unknown. The severity of adverse effects may differ between surgery and non-surgical options, with surgery potentially causing rare severe adverse effects, such as deep wound or systemic infection or nerve injury, which are not plausible risks in non-surgical care. This should be explained to people who consider opting for surgery.
Context
Carpal tunnel syndrome is a compression neuropathy of the median nerve at the wrist. Surgery is considered when symptoms persist despite the use of non-surgical treatments. It is unclear whether surgery produces a better outcome than non-surgical therapy.
Cochrane Systematic Review
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