Context Carpal tunnel syndrome (CTS) can be treated with nonsurgical or surgical
options. However, there is no consensus on the most effective method of treatment.
Objective To compare the short-term and long-term efficacy of splinting and surgery
for relieving the symptoms of CTS.
Design, Setting, and Patients A randomized controlled trial conducted from October 1998 to April 2000
at 13 neurological outpatient clinics in the Netherlands. A total of 176 patients
with clinically and electrophysiologically confirmed idiopathic CTS were assigned
to wrist splinting during the night for at least 6 weeks (89 patients) or
open carpal tunnel release (87 patients); 147 patients (84%) completed the
final follow-up assessment 18 months after randomization.
Main Outcome Measures General improvement, number of nights waking up due to symptoms, and
severity of symptoms.
Results In the intention-to-treat analyses, surgery was more effective than
splinting on all outcome measures. The success rates (based on general improvement)
after 3 months were 80% for the surgery group (62/78 patients) vs 54% for
the splinting group (46/86 patients), which is a difference of 26% (95% confidence
interval [CI], 12%-40%; P<.001). After 18 months,
the success rates increased to 90% for the surgery group (61/68 patients)
vs 75% for the splinting group (59/79 patients), which is a difference of
15% (95% CI, 3%-27%; P = .02). However, by that time
41% of patients (32/79) in the splint group had also received the surgery
Conclusion Treatment with open carpal tunnel release surgery resulted in better
outcomes than treatment with wrist splinting for patients with CTS.