Carpal tunnel syndrome – clinical evidence BMJ

Carpal tunnel syndrome

New evidence; conclusions changed for:

Nerve and tendon gliding exercises One systematic review (search date 2008) and one subsequent RCT added, which compared nerve and/or tendon gliding exercises plus wrist splints versus wrist splints alone. The systematic review and subsequent RCT found no significant differences between nerve and/or tendon gliding exercises plus wrist splints and wrist splints alone in most outcomes for symptom severity and hand function. Categorisation therefore changed from “Unknown effectiveness” to “Unlikely to be beneficial”.

New evidence; conclusion confirmed for:

Corticosteroids (local injection) One systematic review updated (search date 2006) and one systematic review added (search date 2006). The first systematic review found that local corticosteroid injection increased the proportion of people with clinical improvement at 1 month or less, and improved symptoms at 6 weeks, compared with placebo. It also found that local corticosteroids improved symptom severity after 1 month, 8 weeks, and 12 weeks, compared with systemic corticosteroids. The second systematic review identified one additional RCT comparing corticosteroid injection versus placebo or no treatment, but the RCT did not perform between-group comparisons. Categorisation unchanged (Likely to be beneficial).

Corticosteroids (systemic) One systematic review added (search date 2002),which identified no new RCTs to those previously reported in this Clinical Evidence review. Categorisation unchanged (Likely to be beneficial).

Diuretics One systematic review added (search date 2002), which identified no new RCTs to those previously reported in this Clinical Evidence review. Categorisation unchanged (Unknown effectiveness).

NSAIDs One systematic review added (search date 2002), which identified no new RCTs to those previously reported in this Clinical Evidence review. Categorisation unchanged (Unknown effectiveness).

Pyridoxine One systematic review added (search date 2002), which identified no new RCTs to those previously reported in this Clinical Evidence review. Categorisation unchanged (Unknown effectiveness).

Therapeutic ultrasound One systematic review added (search date 2002), which identified no new RCTs to those previously reported in this Clinical Evidence review. Categorisation unchanged (Unknown effectiveness).

Wrist splints One systematic review (search date 2002) and one subsequent RCT added. The systematic review identified no new RCTs to those previously reported in this Clinical Evidence review. The subsequent RCT compared neutral-angle splint, neutral-angle splint with nerve gliding exercises, wrist cock-up splint, and wrist cock-up splint with nerve gliding exercises; however, the RCT did not perform between-group comparisons and is of low quality, and therefore results are difficult to interpret. Categorisation unchanged (Unknown effectiveness).

Endoscopic versus open carpal tunnel release One systematic review (search date 2006) updated and one subsequent RCT added. The systematic review and subsequent RCT found that endoscopic and open carpal tunnel release may be equally effective at improving symptoms of CTS and improving hand function, and that endoscopic carpal tunnel release may shorten the time to return to work or activities of daily living compared with open carpal tunnel release. However, both types of surgery are associated with adverse effects. Categorisation unchanged (Trade-off between benefits and harms).

Surgery versus wrist splint One systematic review updated (search date 2008),which identified no new RCTs to those previously reported in this Clinical Evidence review. Categorisation unchanged (Trade-off between benefits and harms).

Surgery versus local corticosteroid injection One systematic review (search date 2008) updated. The review identified two RCTs with conflicting results. The first RCT found that local corticosteroid injection was more effective than surgery at improving nocturnal paraesthesia at 3 months, but the difference was not significant at 6 months. The second RCT found that surgery improved clinical outcome at 20 weeks compared with local corticosteroid injection; however, the review found no significant difference between the groups in grip strength at 20 weeks. Categorisation unchanged (Trade-off between benefits and harms).

Internal neurolysis in conjunction with open carpal tunnel release One systematic review updated (search date 2006), which identified no new RCTs to those previously reported in this Clinical Evidence review. Categorisation unchanged (Unlikely to be beneficial).

http://clinicalevidence.bmj.com/ceweb/conditions/msd/1114/1114.jsp?rss=true

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