Carpal tunnel syndrome
INTRODUCTION: Carpal tunnel syndrome is a collection of clinical symptoms and signs caused by compression of the median nerve within the carpal tunnel. However, the severity of symptoms and signs does not often correlate well with the extent of nerve compression. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments, non-drug treatments, and surgical treatments for carpal tunnel syndrome? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 33 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: carpal tunnel release surgery (open and endoscopic), diuretics, local corticosteroids injection, non-steroidal anti-inflammatory drugs (NSAIDs), therapeutic ultrasound, and wrist splints.
Ashworth NL. Carpal tunnel syndrome. Clinical Evidence 2014; 08:1114.
Substantive changes at this update
Corticosteroids (local injection) New RCT added. Categorisation unchanged (likely to be beneficial).
Therapeutic ultrasound One systematic review added. Categorisation unchanged (unknown effectiveness).
Wrist splints One systematic reviews added. Categorisation unchanged (unknown effectiveness).
Surgery versus no treatment Existing evidence re-evaluated. Categorisation changed from 'unknown effectiveness' to 'likely to be beneficial' by consensus.
Surgery versus wrist splints One systematic review added. Categorisation unchanged (trade-off between benefits and harms).
Rated by doctors in Relevance Newsworthiness Neurology *** *** Rheumatology ***** ****
Rated by doctors in Relevance Newsworthiness General Practice(GP)/Family Practice(FP) ****** ****** General Internal Medicine-Primary Care(US) ****** ****** Surgery - Orthopaedics ***** *****