Conservative Treatments of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-analysis

To evaluate the comparative efficacy of various conservative treatments for carpal tunnel syndrome (CTS), including manual therapy (MT), local steroid injections, platelet-rich plasma (PRP) injections, extracorporeal shock wave therapy, and low-level laser therapy, through a comprehensive network meta-analysis.

PubMed, Web of Science, Cochrane Library, Embase, SPORTDiscus, and China National Knowledge Infrastructure databases were searched to identify published studies until April 2024.

Randomized controlled trials comparing the efficacy of conservative CTS treatments in individuals with CTS were included.

Data from the included articles were extracted independently by 2 researchers, with any disagreements resolved through consultation with a third author. The extracted data included the first author's name, country/region, publication year, sample size, participants' age, disease severity, symptom duration, intervention parameters, follow-up period, and reported outcomes.

A total of 49 randomized controlled trials involving 11 conservative treatments and 3323 participants were included. The network meta-analysis showed that MT demonstrated the highest efficacy in both short-term and medium-term pain relief with surface under the cumulative ranking curve values of 87.6% and 99.3%, respectively. Dextrose 5% in water and PRP were closely followed in terms of efficacy. Compared to control groups, low-level laser therapy (standardized mean difference=-1.45; 95% CI, -2.16 to -0.74) and extracorporeal shock wave therapy (standardized mean difference=-1.03; 95% CI, -1.86 to -0.20) also showed significant benefits.

This study provides robust evidence that MT and dextrose 5% in water injections are the most effective conservative treatments for CTS which offer valuable insights for clinical decision-making. Further research is needed to assess the long-term efficacy and cost-effectiveness of these interventions.