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Poor Outcome for Neural Surgery (Epineurotomy or Neurolysis) for Carpal Tunnel Syndrome Compared with Carpal Tunnel Release Alone: A Meta-Analysis of Global Outcomes

Chapell, Richard Ph.D.; Coates, Vivian M.B.A.; Turkelson, Charles Ph.D.

doi: 10.1097/01.PRS.0000076222.77125.1F
Original Articles

A meta-analysis was performed on the results of eight studies that compared the global outcomes of patients who received carpal tunnel release with the global outcomes of patients who received carpal tunnel release and neurolysis or epineurotomy. The meta-analysis suggests that patients who received such neural surgery tended to have poorer global outcomes than those who did not (odds ratio, 0.54; 95 percent confidence interval, 0.32 to 0.90). The data are homogenous, and linear-regression analysis indicates that patient attrition did not influence the outcome of the meta-analysis. The results of this meta-analysis indicate that neural surgery is potentially harmful for most patients with carpal tunnel syndrome. The possibility remains that neural surgery may be helpful in special cases, such as in the presence of marked scarring or neural adhesion, but no available evidence specifically documents the benefits and harms of surgery among such patients.

Plymouth Meeting, Pa.

From ECRI.

Received for publication May 30, 2002;

revised November 19, 2002.

Richard Chapell, Ph.D.

ECRI

5200 Butler Pike

Plymouth Meeting, Pa. 19462

rchapell@ecri.org

This article is based on research conducted by the ECRI Evidence-Based Practice Center under contract to the Agency for Healthcare Research and Quality (contract no. 290-97-0020). ECRI is a nonprofit health services research agency and a Collaborating Center for Healthcare Technology Assessment of the World Health Organization.

The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

©2003American Society of Plastic Surgeons