Surgery Better Than Splinting in Carpal Tunnel Syndrome

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Medscape Medical News

Surgery Better Than Splinting in Carpal Tunnel Syndrome

Laurie Barclay, MD

Sept. 11, 2002 ‹ Open surgery for treatment of carpal tunnel syndrome (CTS)

was significantly superior to six weeks of splinting, according to results

of a randomized trial reported in the Sept. 11 issue of The Journal of the

American Medical Association. In opposition to American Academy of Neurology

clinical guidelines, the investigators and editorialist recommend splinting

only while awaiting surgery or for those who refuse surgery.

" Treatment with open carpal tunnel release surgery resulted in better

outcomes than treatment with wrist splinting for patients with CTS, " write

Annette A. M. Gerritsen, PhD, from Vrije Universiteit Medical Center in

Amsterdam, the Netherlands, and colleagues.

From October 1998 to April 2000, 176 patients from 13 neurological

outpatient clinics in the Netherlands with electrophysiologically confirmed

CTS were randomized to six weeks of wrist splinting or open carpal tunnel

release surgery. After three months, the success rate based on general

improvement was 80% (62 of 78 patients) for surgery and 54% (46 of 86

patients) for splinting (difference, 26%; 95% confidence interval [CI],

12%-40%; P<.001). After 18 months, success rates were 90% (61of 68 patients)

for surgery and 75% (59 of 79 patients) for splinting (difference, 15%; 95%

CI, 3%-27%; P=.02). However, by that time, 41% of patients initially treated

with splinting had undergone carpal tunnel release surgery.

In an accompanying editorial, E. F. Shaw Wilgis, MD, from s Hopkins

School of Medicine in Baltimore, land, notes that short-term outcome

measures favoring splinting could reflect the immediate initiation of

splinting at randomization and the median 35-day delay from randomization to

surgery.

He writes that this study " strongly reinforces findings that indicate that

splinting is an excellent adjunctive treatment in early cases, but is

ineffective on a long-term basis for treating this condition, " and he

suggests that " there is no need for patients with CTS to continue to have

pain, functional limitations, or sleep loss when surgery provides such a

favorable outcome. "

JAMA. 2002;288(10):1245-1251, 1281-1282