Modest clinical gains seen with surgery vs. nonsurgical care for carpal tunnel syndrome

A randomized controlled trial of patients with carpal tunnel syndrome without denervation shows that surgery may lead to modest benefits compared to nonsurgical treatment.

“[In] patients with carpal tunnel syndrome without denervation, surgery modestly improves hand function and symptoms by 3 months compared with a multimodality, nonsurgical treatment regimen, and this benefit is sustained through 1 year,” Jeffrey G. Jarvik, MD, of Harborview Medical Center in Seattle, and colleagues wrote in their study.

“However, some patients allocated to surgery reported persistent symptoms, and 61% of patients allocated to nonsurgical treatment avoided surgery altogether. Our study, together with other previous evidence, indicates that surgery is useful for patients with carpal tunnel syndrome,” they wrote.

The research appears in the latest issue of The Lancet.

Jarvik and his colleagues studied 116 patients from eight centers who received either surgical (open or endoscopic debridement) or conservative treatment (hand therapy and, in some cases, ultrasound) for carpal tunnel syndrome.

The investigators used the functional status scale of the Carpal Tunnel Syndrome Assessment Questionnaire (CTSAQ) at 12 months as the primary outcome measure and defined a successful outcome as meeting all of the following criteria:

at least a 30% improvement from baseline CTSAQ function score;
a minimum 30% improvement from baseline CTSAQ symptom severity score; and,
a low score for hand or wrist pain interference with work or household duties.

Researchers who were blinded to the group assignment assessed the patients for up to 1 year.

The investigators found that 44 patients (77%) who were allocated to the surgery group underwent a surgical procedure during the study period. Overall, 1-year follow-up data were available for 49 patients in the surgery group and 52 patients in the nonsurgical group.

While the investigators found that both groups improved during the follow-up, they reported significantly better CTSAQ function and symptom scores in the surgery group at 1 year compared to the nonsurgery group after adjusting for confounding variables.

However, the investigators noted these differences were small and of “moderate clinical relevance.”

The investigators also found that more patients in the surgical group met the criteria for success (46% vs. 27%, respectively) at 1 year. In addition, they found no clinically important adverse events or surgical complications in either group.

Reference:
Jarvik JG, Comstock BA. Kliot M, et al. Surgery versus non-surgical therapy for carpal tunnel syndrome: A randomized parallel-group trial. Lancet. 2009; 374:1074-1081.