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http://www.nytimes.com/2002/09/11/health/11SURG.html

Study Finds Surgery Works Best for Carpal Tunnel Syndrome

By THE ASSOCIATED PRESS

HICAGO, Sept. 10 — Surgery for carpal tunnel syndrome produces better long-term results in most patients than the more common treatment of putting a splint on the wrist, new research suggests.

The syndrome, which is often associated with use of computer keyboards, can cause numbness, tingling and pain in the fingers, hands and wrists. It occurs when tendons leading from the hand become swollen and press on a nerve in a region of the wrist called the carpal tunnel. It affects an estimated five million Americans and is a significant cause of missed work days.

More than 200,000 carpal tunnel operations are done in the United States each year, but splinting is thought to be the most common treatment and is generally tried before surgery is considered.

Splints keep the wrist from bending, easing pressure on a nerve. Surgery involves making a small incision in the wrist and cutting the carpal ligament away from the median nerve to relieve pressure. It is done under local anesthesia and generally takes less than an hour.

In the study, by researchers in the Netherlands, 176 patients had surgery or wore wrist splints for at least six weeks; they were then evaluated periodically. After three months, significant improvement was seen in 80 percent of surgery patients, compared with 54 percent of splint patients. At 18 months, the success rate remained significantly higher for the surgery group.

The findings are to appear Wednesday in The Journal of the American Medical Association.

Because the researchers did not study patients who had very mild or severe cases, the study does not prove that surgery is best for everyone, said Dr. Shaw Wilgis, research director at Curtis National Hand Center in Baltimore. Nor did the study examine anti-inflammatory drugs, which are sometimes prescribed.

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