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.
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