Surgery Best for Carpal Tunnel

Surgery appears to be more effective than splints in bringing long-term relief from carpal tunnel syndrome, a painful condition associated with repetitive, forceful hand motions.

The operation, which involves cutting the ligament over the wrist’s carpal tunnel to relieve pressure on a major nerve, is the fifth-most-common procedure among Medicare patients. It helps alleviate wrist pain, numbness and tingling in the thumb, index and middle fingers.

A new study, from Dr. Annette A.M. Gerritsen at the Institute for Research in Extramural Medicine at Vrije Universiteit Medical Center in Amsterdam, is the first to compare splints, which immobilize the wrist, and surgery. Researchers randomly assigned 176 patients to two groups: 89 were to wear splints at night for at least six weeks and 87 were to undergo surgery. The patients were evaluated by physical therapists at one month, three months, six months and 12 months.

After three months, 80% of the surgical patients had improved, compared with 54% of the splint-wearers, according to the study published in the current issue of the Journal of the American Medical Assn. After 18 months, 90% of the surgery group reported improvement.

Among the splinted group, 41% opted for surgery within the 18 months and 94% of those reported improvement. Those who stuck with splinting alone had a 37% overall improvement rate.

In an accompanying commentary, Dr. E.F. Shaw Wiggis, of the Curtis National Hand Center at Union Memorial Hospital in Baltimore, noted that many patients may not want to expose themselves to surgical risks and potential complications. He advocated studies comparing surgery to other types of treatment, such as anti-inflammatory medications and acupuncture.