Background: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome that is caused by compression of the median nerve at the wrist joint causing variety of signs and symptoms. There are several measures to treat CTS including surgical and non-surgical approaches.

Objectives: this systematic review aims to compare and evaluate the efficacy of conservative (non-surgical) and surgical approaches in treatment of CTS.

Methods: Using predefined keywords related to this condition, an extensive search of medical databases, including PubMed and Cochrane library, was carried out to find and select randomized controlled clinical trials evaluating the effects of conservative treatment compared to surgical treatment released up to August 2023. The quality of the included research was rigorously evaluated, and data were extracted. After reviewing pertinent papers for relevance and quality, data was gathered for analysis. Key outcome measures included pain reduction and functional improvement

Results and Discussion: Through an extensive search of databases, six relevant randomized controlled trials (RCTs) were finally identified. The analysis demonstrates that CTS patients benefit from both conservative treatments and surgical approaches, with surgical interventions showing immediate and significant symptom alleviation. Conservative therapy, on the other hand, led to relatively moderate results. Long-term results and patient satisfaction seemed to favor surgical procedures. The review highlights trade-offs between various treatment modalities and offers insights for clinical decision-making. Long-term impacts, patient preferences, standardized outcome measurements, and cost-effectiveness analyses should all be the main topics of future research. Finally, this analysis contributes to the development of evidence-based management approaches, assisting professionals in enhancing care for CTS patients in primary care settings.

Conclusion: surgery demonstrate immediate and considerable symptom alleviation and functional improvement more than conservative treatment mainly with severe CTS and for long term effect

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Dr Ahmed Elhamalawy

MRCGP UK