Does surgery for carpal tunnel syndrome improve outcomes?
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Good evidence supports the use of surgery for carpal tunnel syndrome over nonsurgical therapies such as wrist splints, nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, occupational therapy, local steroid injections, work modification, and oral vitamin B6 (Grade of Recommendation: A, based on extrapolation from a systematic review of 1 randomized controlled trial [RCT], 1 additional recent RCT, and 2 cohort studies). Surgery is likely worth the extra costs when conservative therapy (up to 3 months) fails to improve symptoms and return of function, because delayed surgery is as successful as surgery performed shortly after diagnosis. Closed endoscopic release and open release surgery are equally effective therapies for controlling symptoms (Grade of Recommendation: C, based on extrapolation from a systematic review of RCTs). However, whether endoscopic release results in more rapid regain of function and return to work is unclear.