Laura Rees Willett, MD, FACP
What is the effectiveness of nonsurgical interventions for the carpal tunnel syndrome (CTS)?
Included studies assessed nonsurgical interventions to treat CTS and reported on outcomes of pain, function, or recovery. Exclusion criteria were CTS caused by acute trauma or systemic disease (e.g., osteoarthritis, rheumatoid arthritis, diabetes mellitus, or other connective tissue disease) and studies on effectiveness of perioperative analgesics.
PubMed, EMBASE/Excerpta Medica, CINAHL, PEDro, and Cochrane Library were searched up to January 2010 for systematic reviews and randomized controlled trials (RCTs). 2 systematic reviews and 20 recent RCTs met the selection criteria (total of 53 RCTs). 29 RCTs (55%) had high quality (scores ≥ 50% based on 12 criteria).
The results for interventions that had strong or moderate evidence of effectiveness are summarized in the Table.
Oral steroids, steroid injections, ultrasonography, magnetic field therapy, nocturnal splinting, ergonomic keyboards (vs standard keyboards), and traditional cupping (vs heat pads) had at least moderate evidence of effectiveness for treatment of the carpal tunnel syndrome in the short-term.
Interventions for treatment of the carpal tunnel syndrome with strong or moderate evidence of effectiveness*
*For all comparisons, evidence favors the first comparator. Strong evidence = consistent (≥ 75% of trials report consistent findings) and positive (significant) findings in multiple, higher-quality (scores ≥ 50% based on 12 criteria) randomized controlled trials (RCTs); moderate evidence = consistent, positive findings in multiple lower-quality RCTs and/or 1 high-quality RCT. Short-term = 0 to 3 mo; mid-term = 4 to 6 mo.
†Patients with type 2 diabetes mellitus.
Willett LR. Review: Steroids, US, electromagnetic field therapy, and nocturnal splinting have moderate, short-term effectiveness for the carpal tunnel syndrome. Ann Intern Med. ;153:JC6–10. doi: 10.7326/0003-4819-153-12-201012210-02010
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Published: Ann Intern Med. 2010;153(12):JC6-10.
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