A Comprehensive Review and Update on Conservative and Surgical Treatment of Carpal Tunnel Syndrome: Current Evidence and Future Research Direction

Carpal tunnel syndrome (CTS) is a multifactorial neuropathy caused by compression of the median nerve at the carpal tunnel. Its symptoms include pain, tingling or numbness affecting mainly the thumb, index and middle finger (sometimes the ring finger is also involved), with this sensation that could travel up the arm; hand weakness (mainly the thumb’s pinching muscles). Symptoms may vary in characteristics and severity and can be confound with other upper arm neuropathies and radiculopathies. The diagnosis is made with accurate history taking and clinical examination, supported by electromyography (EMG) and nerve conduction studies. Most people with mild to moderate symptoms are initially treated non-operatively. However, surgery is thought to provide more effective and durable symptom relief, especially for the most severe cases. CTS is becoming more common, as is its surgical management. This constitutes a significant economic burden for societies. All surgical techniques have provided satisfactory results and have been proven to be effective options. After reviewing the most up to date literature, it could be said that evidence of superiority of one technique over the others is lacking from a high level of evidence point of view. Specific advantages and disadvantages of surgical methods can, however, be taken into account when choosing among treatments. The simple algorithm of leaving the choice of the surgical method to surgeons’ preference and experience (together with consideration of patients’ related factors) seem to be the best available option, which is supported by the most recent metanalysis and systematic reviews. Research towards a universally accepted standardization should be aimed for by the authors, who have failed to date to sufficiently limit bias and limitations.