2024 Jan 08

New citation required and conclusions have changed

Search updated to November 2022. Update completed with new author team. The conclusions have changed as the review now compares surgery with each non‐surgical intervention separately.

2024 Jan 08

New search has been performed

Based on an updated search, nine new studies with 815 randomised participants are included in the review (Awan 2015; Eltabl 2020; Fernandez‐de‐las‐Penas 2015; Fernandez‐de‐las‐Penas 2017a; Fernandez‐de‐las‐Penas 2017b; Ismatullah 2013; Jafari 2018; Jarvik 2009; Zhang 2019); four studies included in the previous version of this review remain included (Garland 1964; Gerritsen 2002; Hui 2005; Ly Pen 2005); one study (67 randomised participants), which was awaiting classification in the previous version of this review, is now included (Ucan 2006).

In contrast with the previous version of this review, we used a random‐effects model as default in the meta‐analyses, instead of a fixed‐effect model.

In the previous version of this review (Verdugo 2008), all studies were pooled together regardless of the comparator in one meta‐analysis. In the updated version, we performed separate meta‐analysis for each different comparator.

Furthermore, we used different data regarding:

• clinical improvement from the studies of Gerritsen 2002 and Garland 1964 (in the previous version, those lost to follow‐up were included as 'not improved', but we used only reported data);

• need for surgery from the studies of Garland 1964 and Ly Pen 2005 (in the previous version, patients who underwent surgery were used in analysis. We used the data for those reported as "in need of surgery" too).

We accepted clinical success or improvement as defined by the authors of the included studies.

We excluded the following secondary outcomes, which were included in the previous version of this review:

• neurophysiological parameters (because their clinical relevance is unclear);

• return to work at 3 months or less of follow‐up.

We included the following secondary outcomes, which were not included in the previous version of this review:

• symptoms;

• function;

• pain (because surgery may cause chronic pain, for example painful scar);

• generic health‐related quality of life.

We used the GRADE approach to assess the certainty of evidence (it was not used in the previous version of this review).

These changes were defined before the screening of the search.

Changes in the clinical implications of the findings: in the previous version of this review, the conclusion stated that surgical treatment of carpal tunnel syndrome is more effective than splinting, but further research was needed to determine its effectiveness for people with mild symptoms and whether it is better than steroid injection.

In the updated version, we have slightly changed the conclusion. Due to generally unclear benefits and harms of surgery, we emphasise the need for a balanced decision‐making process, considering the severity of the disease as well as patients' preferences.

2016 Aug 16

Review declared as stable

This review is not longer being updated. See Published notes.

2017 May 10

Amended

Converted to new review format.