Carpal Tunnel Syndrome: Comparing the Effects of Surgical and Conservative Therapies on Patient Reported Outcomes
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Abstract
Focused Clinical Question: In patients with carpal tunnel syndrome (CTS), what is the effect of conservative treatment compared to surgical intervention on patient reported outcome measures? Search Strategy: Search terms included carpal tunnel, manual therapy, rehabilitation, conservative treatment, surgical decompression, and CTS release. Sources searched included CINAHL, PubMed, ProQuest Nursing Collection, and Cochrane Library, which returned a range of 193 to 309 hits per search. Searches narrowed again to subjective complaints, health survey, symptom checklist, self-reported function, and pain intensity. Inclusion criteria consisted of presence of CTS on one or both hands, participants over the age of 18, and the ability to complete questionnaires in English. Exclusion criteria consisted of previous wrist or hand surgery within 6 months, wrist deformity, arthritis, and pregnancy. Evidence Quality Assessment: Studies for randomized controlled groups were all critically appraised utilizing the Physiotherapy Evidence Database (PEDro) score and Oxford 200 Level of Evidence scales. Included articles scored 6/10, 7/10 or 8/10 on the PEDro checklist. Only two of the seven studies included scored a 3 on the Oxford scale, with the remaining articles scoring a 2. Results and Summary of Search: The evidence reviewed showed that within 6 months and 4 years there was no difference in improvement of patient’s symptoms with choosing surgery over a variety of conservative therapies such as low-level laser therapy, manual therapy, wrist traction and steroid injection. Clinical Scenario: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome1 that accounts for nearly 50% of all work-related injuries.2 This condition is associated with repetitive motions, so it is applicable to athletic populations and workers alike. There is a reported range between 6% and 12% of the general population that suffers from pain from carpal tunnel syndrome.2 This Critically Appraised Topic (CAT) aims to review the current evidence regarding the effectiveness of conservative and surgical treatment on patient reported outcome measures with the intent to guide providers to make evidence-based decisions regarding the proper course of action for carpal tunnel syndrome related pain. Clinical Bottom Line: SORT appraisal resulted in high quality evidence. Overall, the studies included had strong design, with all but two being randomized control trials.1-5 Collectively, the evidence included receives a score of a B. The evidence obtained is good-quality, and patient oriented, but the findings are mildly inconsistent. Though all articles show significant change, there was inconsistency in the preference of surgical or non-surgical techniques. These studies suggest that both surgical and non-surgical treatments of carpal tunnel syndrome led to improved patient reported outcomes. Implications: In months 1-3 post initiation of treatment or surgery, non-surgical treatment was superior.2,6 By 6 months, no statistically significant difference was observed.2,3,4,6 The only exception to this finding suggests though symptoms in both groups improved, surgical treatment led to marginally better symptom scores than non-surgical treatment at the 12 month mark.1 Overall, long term treatment of CTS can be achieved through both surgical intervention and conservative therapies with statistically equivalent satisfaction measured by patient reported outcomes.
College
College of Nursing & Health Sciences
Department
Health, Exercise & Rehabilitative Sciences
Campus
Winona
First Advisor/Mentor
Brian Zeller
Second Advisor/Mentor
Nora Kraemer
Presentation Type
Oral Presentation
Format of Presentation or Performance
Pre-Recorded Video
Carpal Tunnel Syndrome: Comparing the Effects of Surgical and Conservative Therapies on Patient Reported Outcomes
Focused Clinical Question: In patients with carpal tunnel syndrome (CTS), what is the effect of conservative treatment compared to surgical intervention on patient reported outcome measures? Search Strategy: Search terms included carpal tunnel, manual therapy, rehabilitation, conservative treatment, surgical decompression, and CTS release. Sources searched included CINAHL, PubMed, ProQuest Nursing Collection, and Cochrane Library, which returned a range of 193 to 309 hits per search. Searches narrowed again to subjective complaints, health survey, symptom checklist, self-reported function, and pain intensity. Inclusion criteria consisted of presence of CTS on one or both hands, participants over the age of 18, and the ability to complete questionnaires in English. Exclusion criteria consisted of previous wrist or hand surgery within 6 months, wrist deformity, arthritis, and pregnancy. Evidence Quality Assessment: Studies for randomized controlled groups were all critically appraised utilizing the Physiotherapy Evidence Database (PEDro) score and Oxford 200 Level of Evidence scales. Included articles scored 6/10, 7/10 or 8/10 on the PEDro checklist. Only two of the seven studies included scored a 3 on the Oxford scale, with the remaining articles scoring a 2. Results and Summary of Search: The evidence reviewed showed that within 6 months and 4 years there was no difference in improvement of patient’s symptoms with choosing surgery over a variety of conservative therapies such as low-level laser therapy, manual therapy, wrist traction and steroid injection. Clinical Scenario: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome1 that accounts for nearly 50% of all work-related injuries.2 This condition is associated with repetitive motions, so it is applicable to athletic populations and workers alike. There is a reported range between 6% and 12% of the general population that suffers from pain from carpal tunnel syndrome.2 This Critically Appraised Topic (CAT) aims to review the current evidence regarding the effectiveness of conservative and surgical treatment on patient reported outcome measures with the intent to guide providers to make evidence-based decisions regarding the proper course of action for carpal tunnel syndrome related pain. Clinical Bottom Line: SORT appraisal resulted in high quality evidence. Overall, the studies included had strong design, with all but two being randomized control trials.1-5 Collectively, the evidence included receives a score of a B. The evidence obtained is good-quality, and patient oriented, but the findings are mildly inconsistent. Though all articles show significant change, there was inconsistency in the preference of surgical or non-surgical techniques. These studies suggest that both surgical and non-surgical treatments of carpal tunnel syndrome led to improved patient reported outcomes. Implications: In months 1-3 post initiation of treatment or surgery, non-surgical treatment was superior.2,6 By 6 months, no statistically significant difference was observed.2,3,4,6 The only exception to this finding suggests though symptoms in both groups improved, surgical treatment led to marginally better symptom scores than non-surgical treatment at the 12 month mark.1 Overall, long term treatment of CTS can be achieved through both surgical intervention and conservative therapies with statistically equivalent satisfaction measured by patient reported outcomes.
