Effectiveness of surgical versus conservative treatment for carpal tunnel syndrome: A systematic review, meta-analysis and qualitative analysis.

The included randomized and clinical trials had low to moderate methodological quality, with a mean CBRG score of 5.1 out of 11. The meta-analyses had high heterogeneity, including 82% for symptom improvement and 84% for functional improvement. Most studies involved mild to moderate CTS, and many excluded severe thenar muscle atrophy or previous surgery, so results may not apply to severe cases. Conservative treatment varied widely and included steroid injections, splinting, low-level laser therapy, manual physical therapy, and multimodal care, so the effect of any single component cannot be separated. Side effect reporting was inconsistent because definitions and severity levels varied. The complication comparison is uncertain. Some studies did not confirm CTS with nerve conduction studies, so some participants may not have had CTS alone. Data for 18 months or longer were insufficient for meta-analysis, so long-term effectiveness remains unclear. The functional result was null overall, and subgroup findings at six months were not stable when high-quality studies were examined separately.

The authors declared no conflicts of interest and reported no specific funding.

Do not conclude that surgery is the better treatment for every outcome. The six-month symptom result was positive, but overall function did not show a clear advantage, and the conservative treatments studied had fewer complications.