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Surgery Beats Splints for Carpal Tunnel

Aggressive Treatment Needed for Common Wrist Problem

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Sept. 10, 2002 -- Wearing a wrist brace or splint may not be enough to ease the pain and discomfort caused by carpal tunnel syndrome. A new study suggests more aggressive treatment including surgery is a more effective way to provide long-term relief from the symptoms of the increasingly common ailment.

Carpal tunnel syndrome affects about 2% of the general population and more women than men. The condition is frequently work-related and often associated with repetitive motions, such as typing, or those that create hand-arm vibration and put pressure on a nerve within the wrist.

Symptoms include tingling, pain, weakness, and numbness in the fingers, hands, and occasionally the lower arm. Sometimes, carpal tunnel can be alleviated by stopping, limiting, or modifying actions that put pressure on the hands and wrists.

For some sufferers, however, these behavior modifications are not enough to relieve the pain. For them, treatment options may include noninvasive approaches such as wearing a wrist splint, or more aggressive surgical options, such as an operation in which ligaments around the nerve in the wrist are cut to relieve pressure.

Until now, researchers say there have been few head-to-head comparisons of the two approaches to see which is most effective in treating carpal tunnel syndrome over the short and long term.

In this study, 176 people with carpal tunnel syndrome either wore a wrist splint during the night for six weeks or underwent carpal tunnel release surgery. The study appears in the Sept. 11 issue of The Journal of the American Medical Association.

Three months after treatment, success rates were much higher among those who'd had surgery (80%) than those who'd worn splints (54%). Success was defined by a rating from the patient as either "completely recovered" or "much improved."

The success rates grew even higher in the long term. After 18 months, 90% of the surgical group reported success, compared with 75% of the splinting group. But, the researchers say, by that time in the study, 41% of the splint group patients had already opted to receive the surgery.

Study author Annette A.M. Gerritsen, PhD, of the Institute for Research in Extramural Medicine at the Vnije Universiteit Medical Center in Amsterdam, and colleagues say these findings should apply to most people with carpal tunnel syndrome, although the mildest and most severe cases were not included in this study.

In an editorial accompanying the study, E. F. Shaw Wilgis, MD, of the Curtis National Hand Center at Union Memorial Hospital in Baltimore, says these results show that splinting is an excellent treatment in early cases, but is ineffective on a long-term basis for treating carpal tunnel syndrome.

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