A systematic review of conservative treatment of carpal tunnel syndrome

D. B. Piazzini, Irene Aprile, P. E. Ferrara, C. Bertolini, P. Tonali, L. Maggi, A. Rabini, S. Piantelli, L. Padua

Research output: Contribution to journalArticle

131 Citations (Scopus)

Abstract

Objective: To assess the effectiveness of conservative therapy in carpal tunnel syndrome. Data sources: A computer-aided search of MEDLINE and the Cochrane Collaboration was conducted for randomized controlled trials (RCTs) from January 1985 to May 2006. Review methods: RCTs were included if: (1) the patients, with clinically and electrophysiologically confirmed carpal tunnel syndrome, had not previously undergone surgical release, (2) the efficacy of one or more conservative treatment options was evaluated, (3) the study was designed as a randomized controlled trial. Two reviewers independently selected the studies and performed data extraction using a standardized form. In order to assess the methodological quality, the criteria list of the Cochrane Back Review Group for systematic reviews was applied. The different treatment methods were grouped (local injections, oral therapies, physical therapies, therapeutic exercises and splints). Results: Thirty-three RCTs were included in the review. The studies were analysed to determine the strength of the available evidence for the efficacy of the treatment. Our review shows that: (1) locally injected steroids produce a significant but temporary improvement, (2) vitamin B6 is ineffective, (3) steroids are better than non-steroidal anti-inflammatory drugs (NSAIDs) and diuretics, but they can produce side-effects, (4) ultrasound is effective while laser therapy shows variable results, (5) exercise therapy is not effective, (6) splints are effective, especially if used full-time. Conclusion: There is: (1) strong evidence (level 1) on efficacy of local and oral steroids; (2) moderate evidence (level 2) that vitamin B6 is ineffective and splints are effective and (3) limited or conflicting evidence (level 3) that NSAIDs, diuretics, yoga, laser and ultrasound are effective whereas exercise therapy and botulinum toxin B injection are ineffective.

Original languageEnglish
Pages (from-to)299-314
Number of pages16
JournalClinical Rehabilitation
Volume21
Issue number4
DOIs
Publication statusPublished - Apr 2007

Fingerprint

Carpal Tunnel Syndrome
Exercise Therapy
Splints
Randomized Controlled Trials
Vitamin B 6
Steroids
Diuretics
Anti-Inflammatory Agents
Yoga
Injections
Information Storage and Retrieval
Laser Therapy
MEDLINE
Pharmaceutical Preparations
Lasers
Therapeutics
Conservative Treatment

ASJC Scopus subject areas

  • Rehabilitation
  • Health Professions(all)

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A systematic review of conservative treatment of carpal tunnel syndrome. / Piazzini, D. B.; Aprile, Irene; Ferrara, P. E.; Bertolini, C.; Tonali, P.; Maggi, L.; Rabini, A.; Piantelli, S.; Padua, L.

In: Clinical Rehabilitation, Vol. 21, No. 4, 04.2007, p. 299-314.

Research output: Contribution to journalArticle

Piazzini, DB, Aprile, I, Ferrara, PE, Bertolini, C, Tonali, P, Maggi, L, Rabini, A, Piantelli, S & Padua, L 2007, 'A systematic review of conservative treatment of carpal tunnel syndrome', Clinical Rehabilitation, vol. 21, no. 4, pp. 299-314. https://doi.org/10.1177/0269215507077294
Piazzini, D. B. ; Aprile, Irene ; Ferrara, P. E. ; Bertolini, C. ; Tonali, P. ; Maggi, L. ; Rabini, A. ; Piantelli, S. ; Padua, L. / A systematic review of conservative treatment of carpal tunnel syndrome. In: Clinical Rehabilitation. 2007 ; Vol. 21, No. 4. pp. 299-314.
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AB - Objective: To assess the effectiveness of conservative therapy in carpal tunnel syndrome. Data sources: A computer-aided search of MEDLINE and the Cochrane Collaboration was conducted for randomized controlled trials (RCTs) from January 1985 to May 2006. Review methods: RCTs were included if: (1) the patients, with clinically and electrophysiologically confirmed carpal tunnel syndrome, had not previously undergone surgical release, (2) the efficacy of one or more conservative treatment options was evaluated, (3) the study was designed as a randomized controlled trial. Two reviewers independently selected the studies and performed data extraction using a standardized form. In order to assess the methodological quality, the criteria list of the Cochrane Back Review Group for systematic reviews was applied. The different treatment methods were grouped (local injections, oral therapies, physical therapies, therapeutic exercises and splints). Results: Thirty-three RCTs were included in the review. The studies were analysed to determine the strength of the available evidence for the efficacy of the treatment. Our review shows that: (1) locally injected steroids produce a significant but temporary improvement, (2) vitamin B6 is ineffective, (3) steroids are better than non-steroidal anti-inflammatory drugs (NSAIDs) and diuretics, but they can produce side-effects, (4) ultrasound is effective while laser therapy shows variable results, (5) exercise therapy is not effective, (6) splints are effective, especially if used full-time. Conclusion: There is: (1) strong evidence (level 1) on efficacy of local and oral steroids; (2) moderate evidence (level 2) that vitamin B6 is ineffective and splints are effective and (3) limited or conflicting evidence (level 3) that NSAIDs, diuretics, yoga, laser and ultrasound are effective whereas exercise therapy and botulinum toxin B injection are ineffective.

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