Carpal Tunnel surgery effective

In patients with mild-to-moderate carpal tunnel syndrome who've tried splinting without success, surgery produces greater functional and symptomatic improvements than nonsurgical treatment, a Lancet study shows.

Among more than 100 patients randomized to surgery or nonsurgical therapy (including splinting and hand exercises), substantial crossover occurred. Intent-to-treat analyses showed 67% of patients had functional improvement of 30% or more at 1 year with surgery, compared to 46% with nonsurgical treatment. In as-treated analyses, improvements were 73% and 33%, respectively. Surgery was not associated with any "clinically important" adverse events.

The authors write that differences between the groups, while statistically significant, were "of moderate clinical relevance."

Commentators conclude that although nonsurgical treatments have their place, especially for those with short histories of carpal tunnel, "patients ... who do not have satisfactory improvement with non-surgical treatment should be offered surgery."