Effectiveness of Surgical and Postsurgical Interventions for Carpal Tunnel Syndrome-A Systematic Review

Arch Phys Med Rehabil. 2018 Aug;99(8):1660-1680.e21. doi: 10.1016/j.apmr.2017.04.024. Epub 2017 May 31.


Objective: To present an evidence-based overview of the effectiveness of surgical and postsurgical interventions for carpal tunnel syndrome (CTS).

Data sources: The Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro were searched for relevant systematic reviews and randomized controlled trials (RCTs) up to April 8, 2016.

Study selection: Two reviewers independently applied the inclusion criteria to select potential studies.

Data extraction: Two reviewers independently extracted the data and assessed the methodologic quality.

Data synthesis: A best-evidence synthesis was performed to summarize the results. Four systematic reviews and 33 RCTs were included. Surgery versus nonsurgical interventions, timing of surgery, and various surgical techniques and postoperative interventions were studied. Corticosteroid injection was more effective than surgery (strong evidence, short-term). Surgery was more effective than splinting or anti-inflammatory drugs plus hand therapy (moderate evidence, midterm and long-term). Manual therapy was more effective than surgical treatment (moderate evidence, short-term and midterm). Within surgery, corticosteroid irrigation of the median nerve before skin closure as additive to CTS release or the direct vision plus tunneling technique was more effective than standard open CTS release (moderate evidence, short-term). Furthermore, short was more effective than long bulky dressings, and a sensory retraining program was more effective than no program after surgery (moderate evidence, short-term). For all other interventions only conflicting, limited, or no evidence was found.

Conclusions: Surgical treatment seems to be more effective than splinting or anti-inflammatory drugs plus hand therapy in the short-term, midterm, and/or long-term to treat CTS. However there is strong evidence that a local corticosteroid injection is more effective than surgery in the short-term, and moderate evidence that manual therapy is more effective than surgery in the short-term and midterm. There is no unequivocal evidence that suggests one surgical treatment is more effective than the other. Postsurgical, a short- (2-3 days) favored a long-duration (9-14 days) bulky dressing and a sensory retraining program seems to be more effective than no program in short-term. More research regarding the optimal timing of surgery for CTS is needed.

Keywords: Carpal tunnel syndrome; Orthopaedics; Rehabilitation; Review; Surgery, Plastic; Treatment outcome.

Publication types

  • Systematic Review

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage
  • Carpal Bones / surgery*
  • Carpal Tunnel Syndrome / surgery*
  • Humans
  • Injections
  • Median Nerve / surgery*
  • Musculoskeletal Manipulations / methods
  • Musculoskeletal Manipulations / statistics & numerical data
  • Physical Therapy Modalities / statistics & numerical data*
  • Postoperative Care / methods
  • Postoperative Care / statistics & numerical data*
  • Postoperative Period


  • Adrenal Cortex Hormones