Splinting vs surgery for CTS (Gerritsen)

Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomized controlled trial

Gerritsen AA, de Vet HC, Scholten RJ, et al. JAMA 2002 · PMID 12215131 · doi:10.1001/jama.288.10.1245

Question

Is open carpal tunnel release more effective than wrist splinting for idiopathic carpal tunnel syndrome?

Design

Multicentre Dutch RCT with 18-month follow-up.

Patients

Adults with idiopathic carpal tunnel syndrome confirmed clinically and on nerve conduction studies.

Intervention

Open carpal tunnel release

Comparison

Night-time wrist splinting

Primary outcome

Patient-reported general improvement over 18 months

Key result

Surgery gave significantly higher success rates than splinting at all follow-up points, and many patients in the splint group went on to request surgery.

Limitations

Unblinded; splinting regimen limited to night use; Dutch referral population may differ from UK primary care.

Impact on practice

Established that splinting is a reasonable temporary measure for mild symptoms but that surgery is more effective for confirmed CTS.