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Effectiveness of Surgical and Postsurgical Interventions for Carpal Tunnel Syndrome—A Systematic Review

      Abstract

      Objective

      To present an evidence-based overview of the effectiveness of surgical and postsurgical interventions for carpal tunnel syndrome (CTS).

      Data Sources

      The Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro were searched for relevant systematic reviews and randomized controlled trials (RCTs) up to April 8, 2016.

      Study Selection

      Two reviewers independently applied the inclusion criteria to select potential studies.

      Data Extraction

      Two reviewers independently extracted the data and assessed the methodologic quality.

      Data Synthesis

      A best-evidence synthesis was performed to summarize the results. Four systematic reviews and 33 RCTs were included. Surgery versus nonsurgical interventions, timing of surgery, and various surgical techniques and postoperative interventions were studied. Corticosteroid injection was more effective than surgery (strong evidence, short-term). Surgery was more effective than splinting or anti-inflammatory drugs plus hand therapy (moderate evidence, midterm and long-term). Manual therapy was more effective than surgical treatment (moderate evidence, short-term and midterm). Within surgery, corticosteroid irrigation of the median nerve before skin closure as additive to CTS release or the direct vision plus tunneling technique was more effective than standard open CTS release (moderate evidence, short-term). Furthermore, short was more effective than long bulky dressings, and a sensory retraining program was more effective than no program after surgery (moderate evidence, short-term). For all other interventions only conflicting, limited, or no evidence was found.

      Conclusions

      Surgical treatment seems to be more effective than splinting or anti-inflammatory drugs plus hand therapy in the short-term, midterm, and/or long-term to treat CTS. However there is strong evidence that a local corticosteroid injection is more effective than surgery in the short-term, and moderate evidence that manual therapy is more effective than surgery in the short-term and midterm. There is no unequivocal evidence that suggests one surgical treatment is more effective than the other. Postsurgical, a short- (2-3 days) favored a long-duration (9-14 days) bulky dressing and a sensory retraining program seems to be more effective than no program in short-term. More research regarding the optimal timing of surgery for CTS is needed.

      Keywords

      List of abbreviations:

      CI (confidence interval), CTS (carpal tunnel syndrome), MD (mean difference), RCT (randomized controlled trial), RR (relative risk), SMD (standardized mean difference)
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      • Correction
        Archives of Physical Medicine and RehabilitationVol. 101Issue 9
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          In the article by Huisstede et al, Effectiveness of Surgical and Postsurgical Interventions for Carpal Tunnel Syndrome - A Systematic Review, published in the Archives of Physical Medicine and Rehabilitation 2018; 99 : 1660-1680 https:// www.archives-pmr.org/article/S0003-9993(17 )30372-6/fulltext, the cited paper by Vanni et al, The double tunnels technique: an alternative minimally invasive approach for carpal tunnel syndrome published in J Neurosurg 2015;123:1230-7 was erroneously interpreted. This study compares two surgical procedures for carpal tunnel syndrome, the aforementioned double tunnels technique and a standard open decompression of the median nerve.
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