Surgical Treatment of Carpal Tunnel Syndrome: A Health Technology Assessment

Abstract

Key message Carpal tunnel syndrome is a compressive neuropathic disorder, leading to typical symptoms of numbness, tingling and pain in the hand. Surgical treatment with release of the transverse ligament of the wrist is an established treatment. In Norway, a geographic variation in the provision of surgery has been observed. We conducted a health technology assessment of surgical treatment compared to non-surgical treatments with splinting, combinations of non-surgical treatments, local corticosteroid injection and physical therapy (including manual therapy). For evaluation of efficacy and safety, we included 10 randomized controlled trials. We found that: • Surgery may slightly improve symptoms and hand function compared to splinting and combinations of non-surgical treatment in patients with mild to moderate carpal tunnel syndrome (low-certainty evidence). • The efficacy of surgery compared to corticosteroid injection and surgery compared to manual therapy is uncertain due to very low-certainty evidence. • No trials reported outcomes separately for subpopulations with mild, moderate or severe carpal tunnel syndrome. • Overall, few adverse events were reported after the surgical and non-surgical treatments. • Surgery in patients with mild to moderate carpal tunnel syndrome is the most costly treatment alternative at about Norwegian kroner (NOK) 11,200. Non-surgical treatment alternatives with splinting and local corticosteroid injection cost around NOK 3,100. Potential cost savings depend on the reduction of surgical procedures per health region. We estimated the potential cost savings at the national level to be between NOK 14.5 and 27.5 million over five years.