Surgery vs non-surgical therapy for CTS (Jarvik)

Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomised parallel-group trial

Jarvik JG, Comstock BA, Kliot M, et al. Lancet (London, England) 2009 · PMID 19782873 · doi:10.1016/s0140-6736(09)61517-8

Question

In carpal tunnel syndrome without denervation, does surgical release give better outcomes than multimodal non-surgical treatment?

Design

Multicentre parallel-group RCT across academic and private practice centres in the USA, with blinded outcome assessment.

Patients

Adults with clinically and electrophysiologically confirmed carpal tunnel syndrome without thenar denervation.

Intervention

Open or endoscopic carpal tunnel release

Comparison

Structured non-surgical treatment (hand therapy and ultrasound)

Primary outcome

Carpal tunnel syndrome assessment questionnaire (CTSAQ) function score at 12 months

Key result

Surgery gave significantly greater improvement in function and symptoms at 12 months, although both groups improved and the size of the difference was modest.

Limitations

Not all patients allocated to surgery had it; the non-surgical arm did not include steroid injection; patients could not be blinded to treatment.

Impact on practice

Supports offering carpal tunnel release to patients with confirmed CTS whose symptoms are significant, rather than prolonged conservative care.