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Surgery Better Than Splinting in Carpal Tunnel Syndrome
Journal of the American Medical Association (JAMA)
09/11/2002
By Elda Hauschildt
Treating carpal tunnel syndrome (CTS) with open carpal tunnel release surgery results in better outcomes than treatment with wrist splints.
Dutch researchers report an 80 percent success rate at three months with surgery, compared to a 54 percent success rate with wrist splinting. At 18 months, the success rates increased to 90 percent of surgery patients and 75 percent of splinting patients.
The investigators based success on general improvement in participants.
They suggest splints might be used while patients wait for surgery, since waiting periods for such surgery can often be long.
"Patients not willing to undergo surgery could also be offered a splint," say the researchers led by Dr. Annette Gerritsen of Vrije Universiteit Medical Centre in Amsterdam.
The researchers point out that splinting provides more symptom relief for patients than not receiving treatment for CTS.
One hundred and seventy six patients with clinically and electro-physiologically confirmed idiopathic CTS were enrolled in a randomised, controlled trial from October 1998 to April 2000. Participants attended one of 13 neurological outpatient clinics in the Netherlands.
Eight nine participants were assigned to wrist splinting during the night, for at least six weeks and the remaining 87 patients had surgery.
Follow-up assessment was done 18 months after randomisation and included 147 of the patients (84 percent). By 18 months, 41 percent of patients in the splint group had also received surgery.
Surgery was more effective than splinting on all outcome measures, investigators found. Outcome measures included general improvement, number of nights waking due to symptoms and symptom severity.
The researchers comment: "We believe that the results of this trial are applicable to most patients with clinically and electro-physiologically confirmed idiopathic CTS. However, the least severe and the most severe cases were probably not included in this trial.
"These patients (or doctors) typically have a strong preference for splinting or surgery."
JAMA, 2002; 288: 1245-1251
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