Surgery may be more effective than wrist braces for easing the pain of carpal tunnel syndrome, a new research review.
Carpal tunnel syndrome is caused by pressure on the median nerve, which runs through a narrow passageway in the wrist -- the carpal tunnel. Symptoms include pain, numbness and weakness in the hand, fingers and wrist, while severe cases can cause a permanent loss of feeling or partial paralysis.
There is no universally accepted first-line treatment for carpal tunnel syndrome, but the options include wrist splints that immobilize the joint, anti- inflammatory painkillers, injections of inflammation-fighting corticosteroids and surgery in which the ligaments surrounding the median nerve are cut to relieve pressure on the nerve.
The new review, based on four recent clinical trials involving 317 patients, suggests that surgery is more likely to bring relief than wrist splints are. Across the studies, surgery patients reported greater improvements in pain, numbness and muscle weakness by 3 months to 1 year after treatment.
Whether surgery also bests steroid injections is not clear from the studies, the researchers report in the Cochrane Library.
However, another recent research review found that while steroid injections seem to ease carpal tunnel syndrome pain in the first month, there is little evidence they worked in the longer-term. That review also appeared in the Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research.
The findings do not mean that surgery is the best option for all carpal tunnel syndrome sufferers, however. People with transient carpal tunnel symptoms may still find some relief from wearing a splint, lead researcher Dr. Renato J. Vertigo, of the University of Chile in Santiago, told Reuters Health.
That includes pregnant women with carpal tunnel syndrome, for example, Verdugo said, as their symptoms often improve after giving birth.
And since many people prefer to avoid surgery, more conservative therapies are often recommended at first, particularly if the symptoms began recently and are not constant or severe.
SOURCE: Cochrane Library, online October 8, 2008.