Local corticosteroid injection versus surgery for carpal tunnel syndrome

Area of Science:

• Orthopedics
• Neurology
• Evidence-based medicine

Background:

• Carpal tunnel syndrome (CTS) is a prevalent condition causing median nerve irritation at the wrist.
• The economic burden of CTS is significant, with surgery costs in the US alone reaching billions.
• The efficacy of local corticosteroid injection (LCI) for CTS is debated, necessitating further clinical evaluation.

Purpose of the Study:

• To compare the benefits and harms of local corticosteroid injections (LCI) versus surgical interventions for carpal tunnel syndrome (CTS).

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs.
• Searched multiple databases including Cochrane, MEDLINE, Embase, and ClinicalTrials.gov up to May 2022.
• Included studies comparing LCI to surgical treatment in adult CTS patients, assessing various outcomes.

Main Results:

• Seven studies with 569 hands were included; data from two studies were unusable.
• Both surgery and LCI showed improvements, but evidence was too uncertain to draw reliable conclusions on symptom relief at up to three months (SMD 0.63, 95% CI -0.61 to 1.88).
• Uncertainty also characterized longer-term symptom relief, functional improvement, and quality of life; surgery may offer greater neurophysiological improvement (MD 0.87 ms).

Conclusions:

• Current evidence comparing LCI to surgery for CTS is too uncertain to support reliable conclusions for short-term or up to 12-month follow-up.
• Further high-quality research is required to establish definitive treatment guidelines for carpal tunnel syndrome.