Carpal tunnel syndrome: a systematic review of conservative and surgical treatments on pain and functional recovery

Abstract

Objective: To compare the efficacy of conservative versus surgical treatments for carpal tunnel syndrome (CTS) and evaluate the role of ultrasound in diagnosis and therapeutic monitoring. Methods: A systematic review was conducted following PRISMA guidelines, including 6 studies (RCTs, cohort analyses, and systematic reviews) retrieved from PubMed. Eligibility criteria focused on adults with CTS, comparing conservative (splinting, manual therapy) and surgical interventions. Outcomes included pain reduction (VAS/NPRS), functional recovery (BCTQ), grip strength, and electrophysiological parameters. Studies were assessed for quality using the Mixed Methods Appraisal Tool (MMAT). Results: Conservative therapies demonstrated significant short-term pain relief (ΔVAS: 2.8–4.1, p<0.05) and functional improvement in mild-to-moderate CTS. Surgery showed superior long-term efficacy (ΔVAS: −4.5 at 12 months, p<0.001) in severe cases. Functional outcomes (BCTQ) were comparable between groups at 12 months. Heterogeneity in study designs (e.g., splinting protocols) and underreported electrophysiological data (28.6% of studies) limited comparability. Final considerations: Conservative and surgical treatments are complementary, with stratified approaches recommended based on severity. Standardized metrics and multicenter trials are needed to optimize clinical guidelines.