Effectiveness of surgical versus conservative treatment for carpal tunnel syndrome: A systematic review, meta-analysis and qualitative analysis
Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. Treatment options include physiotherapy, splinting, steroid injections or surgery. Objective: To compare the effectiveness of surgical versus conservative treatment for CTS for symptom and functional...
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| Format: | Article |
| Language: | English |
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World Scientific Publishing
2018-12-01
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| Series: | Hong Kong Physiotherapy Journal |
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| Online Access: | http://www.worldscientific.com/doi/pdf/10.1142/S1013702518500087 |
| _version_ | 1828262588024094720 |
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| author | Diony Klokkari Ioannis Mamais |
| author_facet | Diony Klokkari Ioannis Mamais |
| author_sort | Diony Klokkari |
| collection | DOAJ |
| description | Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. Treatment options include physiotherapy, splinting, steroid injections or surgery.
Objective: To compare the effectiveness of surgical versus conservative treatment for CTS for symptom and functional improvement and improvement of neurophysiological parameters.
Methods: Systematic searches of PubMed and EBSCO host were conducted to identify the studies published between 1990 and 2016, comparing any surgical treatment to any conservative treatment. Participants were adults with a diagnosis of CTS, with symptom duration ranging from 8 months to 3 years. A meta-analysis and a qualitative analysis were conducted to summarize the results of the included studies and establish any agreement between the two.
Results: A total of 15 studies were included in the study and 10 were included in the meta-analysis, involving 1787 wrists. The qualitative and quantitative analyses were consistent with the results of both indicating that surgical treatment leads to a greater improvement of symptoms at six months (mean difference: 0.52, 95%CI 0.27 to 0.78) and a greater improvement of neurophysiological parameters [distal motor latency (mean difference: 0.31, 95%CI 0.06 to 0.56), sensory nerve conduction velocity (mean difference: 3.71 m/s, 95%CI 1.94 to 5.49)]. At 3 months and 12 months, the results were not significant in favor of surgery or conservative treatment.
Conclusion: Conservative treatment for CTS should be preferred for mild and short-term CTS. Surgery is more effective than conservative in CTS, and should be considered in persisting symptoms, taking into account the complications, which are more severe after surgery. Further research should focus on the field of manual therapy and compare it to surgical treatment for CTS. |
| first_indexed | 2024-04-13T03:58:10Z |
| format | Article |
| id | doaj.art-e000fe5b8b8f48c9a1196770bd5b8f89 |
| institution | Directory Open Access Journal |
| issn | 1013-7025 1876-441X |
| language | English |
| last_indexed | 2024-04-13T03:58:10Z |
| publishDate | 2018-12-01 |
| publisher | World Scientific Publishing |
| record_format | Article |
| series | Hong Kong Physiotherapy Journal |
| spelling | doaj.art-e000fe5b8b8f48c9a1196770bd5b8f892022-12-22T03:03:35ZengWorld Scientific PublishingHong Kong Physiotherapy Journal1013-70251876-441X2018-12-013829111410.1142/S101370251850008710.1142/S1013702518500087Effectiveness of surgical versus conservative treatment for carpal tunnel syndrome: A systematic review, meta-analysis and qualitative analysisDiony Klokkari0Ioannis Mamais1Private Physiotherapist, MSc, Nicosia, CyprusDepartment of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, GreeceBackground: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. Treatment options include physiotherapy, splinting, steroid injections or surgery. Objective: To compare the effectiveness of surgical versus conservative treatment for CTS for symptom and functional improvement and improvement of neurophysiological parameters. Methods: Systematic searches of PubMed and EBSCO host were conducted to identify the studies published between 1990 and 2016, comparing any surgical treatment to any conservative treatment. Participants were adults with a diagnosis of CTS, with symptom duration ranging from 8 months to 3 years. A meta-analysis and a qualitative analysis were conducted to summarize the results of the included studies and establish any agreement between the two. Results: A total of 15 studies were included in the study and 10 were included in the meta-analysis, involving 1787 wrists. The qualitative and quantitative analyses were consistent with the results of both indicating that surgical treatment leads to a greater improvement of symptoms at six months (mean difference: 0.52, 95%CI 0.27 to 0.78) and a greater improvement of neurophysiological parameters [distal motor latency (mean difference: 0.31, 95%CI 0.06 to 0.56), sensory nerve conduction velocity (mean difference: 3.71 m/s, 95%CI 1.94 to 5.49)]. At 3 months and 12 months, the results were not significant in favor of surgery or conservative treatment. Conclusion: Conservative treatment for CTS should be preferred for mild and short-term CTS. Surgery is more effective than conservative in CTS, and should be considered in persisting symptoms, taking into account the complications, which are more severe after surgery. Further research should focus on the field of manual therapy and compare it to surgical treatment for CTS.http://www.worldscientific.com/doi/pdf/10.1142/S1013702518500087Carpal tunnel syndromemedian nerve entrapmentsurgical treatmentconservative treatmentsystematic reviewmeta-analysis |
| spellingShingle | Diony Klokkari Ioannis Mamais Effectiveness of surgical versus conservative treatment for carpal tunnel syndrome: A systematic review, meta-analysis and qualitative analysis Hong Kong Physiotherapy Journal Carpal tunnel syndrome median nerve entrapment surgical treatment conservative treatment systematic review meta-analysis |
| title | Effectiveness of surgical versus conservative treatment for carpal tunnel syndrome: A systematic review, meta-analysis and qualitative analysis |
| title_full | Effectiveness of surgical versus conservative treatment for carpal tunnel syndrome: A systematic review, meta-analysis and qualitative analysis |
| title_fullStr | Effectiveness of surgical versus conservative treatment for carpal tunnel syndrome: A systematic review, meta-analysis and qualitative analysis |
| title_full_unstemmed | Effectiveness of surgical versus conservative treatment for carpal tunnel syndrome: A systematic review, meta-analysis and qualitative analysis |
| title_short | Effectiveness of surgical versus conservative treatment for carpal tunnel syndrome: A systematic review, meta-analysis and qualitative analysis |
| title_sort | effectiveness of surgical versus conservative treatment for carpal tunnel syndrome a systematic review meta analysis and qualitative analysis |
| topic | Carpal tunnel syndrome median nerve entrapment surgical treatment conservative treatment systematic review meta-analysis |
| url | http://www.worldscientific.com/doi/pdf/10.1142/S1013702518500087 |
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