TUESDAY, Sept. 10, 2002 (HealthDayNews) -- Surgery surpasses splinting as the best way to treat the painful wrist condition called carpal tunnel syndrome, Dutch researchers say.
In the carefully controlled study, the success rate was significantly higher for patients who had surgery, rather than the most widely used alternative treatment, putting the wrist in a splint for a prolonged period, says a report appearing in tomorrow's issue of the Journal of the American Medical Association.
There has been no consensus about the optimum treatment for carpal tunnel syndrome, says Annette A.M. Gerritsen, an epidemiologist at Vrije Universiteit Medical Center in Amsterdam, lead author of the journal report. "That is the reason we conducted this trial, and maybe now there will be consensus that surgery is the preferred method of treatment," she says.
The study included 176 patients from 13 neurological clinics in the Netherlands. Half got surgery, half got splinting. After three months, the success rate, based on general improvement of function, was 80 percent for the surgery patients, 54 percent for the splinting group. After 18 months, the success rate was 90 percent for surgery, 75 percent for splinting, and 41 percent of those in the original splinting group had undergone surgery.
"Surgery does put a greater demand on physicians and on patients," Gerritsen acknowledges. "However, carpal tunnel surgery is a minor operation, with limited risks of complications. It is an outpatient procedure, which takes only half an hour, all inclusive." The operation is done under local or regional anesthesia, and patients generally can use their hands the next day.
Carpal tunnel syndrome occurs when overuse or swelling puts pressure on the median nerve, which runs through a narrow channel -- the carpal tunnel -- in the wrist. It causes numbness or pain in the thumb and first three fingers. Putting the wrist in a splint for weeks, often accompanied by injection of corticosteroid drugs, can relieve the symptoms. Surgery cuts a ligament that puts pressure on the nerve.
The Dutch study is important because it is one of very few that have been done under randomized conditions, the gold standard of medical research, says Dr. E.F. Shaw Wilgis, director of research at the Curtis National Hand Center in Baltimore, who wrote an accompanying editorial.
The study results "suggest that there is no need for patients with carpal tunnel syndrome to continue to have pain, functional limitations or sleep loss when surgery provides such a favorable outcome," he says.
Those patients are likely to be women, because "there is definitely a hormonal component" to carpal tunnel syndrome, Wilgis says. The condition is common in menopause and pregnancy, when hormonal changes cause swelling that increases pressure on the median nerve, he says. Thyroid disease, diabetes, and arthritis also increase the risk.
He is a skeptic about the common belief that working with a computer is a major cause of carpal tunnel syndrome. "If you are susceptible, it [computer work] will increase the risk," Wilgis says. "But a typical patient does not know how or why it started. The average person just gets it."
Standard references to carpal tunnel syndrome do not emphasize surgery. For example, the Web site of the National Institute of Neurological Diseases and Stroke says that "only a small percent of patients require surgery."
Wilgis is running his own study on the effectiveness of surgery in carpal tunnel syndrome. The study eventually will enroll 1,000 people and "is about halfway through," he says. Meanwhile, he says of the new report, "I think this article gives sufficient evidence that surgery is the preferred method of treatment."
What To Do
Because the study is small, it isn't the last word in treating the disorder -- at least not yet. Some people want to avoid surgery, even low-risk surgery.
You can get more information about carpal tunnel syndrome from the National Institute of Neurological Diseases and Stroke or the National Institute for Occupational Safety and Health.
