Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomized controlled trial |
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| Authors: | Gerritsen Annette A M de Vet Henrica C W Scholten Rob J P M Bertelsmann Frits W de Krom Marc C T F M Bouter Lex M |
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| Affiliation: | Institute for Research in Extramural Medicine, Vrije Universiteit Medical Center, Amsterdam, the Netherlands (Drs Gerritsen, de Vet, and Bouter); Dutch Cochrane Center/Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (Dr Scholten); Department of Neurology, Amstelveen Hospital, Amstelveen, the Netherlands (Dr Bertelsmann); and Department of Neurology, Maastricht University Hospital, Maastricht, the Netherlands (Dr de Krom). |
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| Abstract: | ![]()
Context Carpal tunnel syndrome (CTS) can be treated with nonsurgical or surgical options. However, there is no consensus on the most effective method of treatment. Objective To compare the short-term and long-term efficacy of splinting and surgery for relieving the symptoms of CTS. Design, Setting, and Patients A randomized controlled trial conducted from October 1998 to April 2000 at 13 neurological outpatient clinics in the Netherlands. A total of 176 patients with clinically and electrophysiologically confirmed idiopathic CTS were assigned to wrist splinting during the night for at least 6 weeks (89 patients) or open carpal tunnel release (87 patients); 147 patients (84%) completed the final follow-up assessment 18 months after randomization. Main Outcome Measures General improvement, number of nights waking up due to symptoms, and severity of symptoms. Results In the intention-to-treat analyses, surgery was more effective than splinting on all outcome measures. The success rates (based on general improvement) after 3 months were 80% for the surgery group (62/78 patients) vs 54% for the splinting group (46/86 patients), which is a difference of 26% (95% confidence interval [CI], 12%-40%; P<.001). After 18 months, the success rates increased to 90% for the surgery group (61/68 patients) vs 75% for the splinting group (59/79 patients), which is a difference of 15% (95% CI, 3%-27%; P = .02). However, by that time 41% of patients (32/79) in the splint group had also received the surgery treatment. Conclusion Treatment with open carpal tunnel release surgery resulted in better outcomes than treatment with wrist splinting for patients with CTS. |
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