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Introduction <p>Carpal Tunnel Syndrome (CTS) is the most prevalent entrapment neuropathy. While surgical decompression and local corticosteroid injections are established treatments, their relative long-term efficacy remains debated. This meta-analysis evaluates the comparative efficacy of surgery versus corticosteroid injections, incorporating the recent large-scale DISTRICTS trial.</p> Methods and Materials <p>Following PRISMA guidelines, we searched PubMed, Cochrane Library, Scopus, and Embase through December 20, 2025, for randomised controlled trials (RCTs) comparing surgery to corticosteroid injections. Primary outcomes included patient recovery (Risk Ratio [RR]) and mean symptom severity (Standardised Mean Difference [SMD]). Meta-analysis was performed using a random-effects model, and evidence quality was assessed via the GRADE scale.</p> Results <p>Seven RCTs involving 1,463 wrists were included. Initial pooled analysis showed no significant difference between surgery and corticosteroid injections in post-procedural symptom severity (SMD: −0.55; 95% CI: −1.85–0.76; <i>p</i> = 0.41; I^2 = 95%) or recovery (RR:1.49; 95% CI: 0.98–2.26; <i>p</i> = 0.06; I^2 = 91%). However, a sensitivity analysis excluding one short-term study revealed a significant recovery advantage for surgery at 5–6&#xa0;months (RR: 1.70; 95% CI: 1.10–2.63; <i>p</i> = 0.02). Grading of Recommendations Assessment, Development, and Evaluation (GRADE) quality of evidence was ‘Very Low’ due to high heterogeneity and risk of bias.</p> Conclusion <p>Surgical intervention preliminarily hints at slightly better recovery rates compared to corticosteroid in the medium-to-long term. However, significant heterogeneity and the exploratory nature of these findings necessitate caution, and results are likely to change with the incorporation of future studies with different methodologies given the ‘Very Low’ GRADE rating for the quality of synthesised evidence. High-quality RCTs with standardised outcome definitions and longer follow-up benchmarks are required to establish definitive clinical guidelines.</p>

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Efficacy of Surgery versus Corticosteroids for Carpal Tunnel Syndrome: A GRADE-Assessed Systematic Review and Meta-analysis of Randomised Controlled Trials

  • 期刊论文

  • 发表日期：

    2026年5月7日

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  • Asad Malik,
  • Abbas Shahid,
  • Adil Shaikh,
  • Ali Bukhari,
  • Saad Maqsood,
  • Syed Hasham Ali

摘要

Introduction

Carpal Tunnel Syndrome (CTS) is the most prevalent entrapment neuropathy. While surgical decompression and local corticosteroid injections are established treatments, their relative long-term efficacy remains debated. This meta-analysis evaluates the comparative efficacy of surgery versus corticosteroid injections, incorporating the recent large-scale DISTRICTS trial.

Methods and Materials

Following PRISMA guidelines, we searched PubMed, Cochrane Library, Scopus, and Embase through December 20, 2025, for randomised controlled trials (RCTs) comparing surgery to corticosteroid injections. Primary outcomes included patient recovery (Risk Ratio [RR]) and mean symptom severity (Standardised Mean Difference [SMD]). Meta-analysis was performed using a random-effects model, and evidence quality was assessed via the GRADE scale.

Results

Seven RCTs involving 1,463 wrists were included. Initial pooled analysis showed no significant difference between surgery and corticosteroid injections in post-procedural symptom severity (SMD: −0.55; 95% CI: −1.85–0.76; p = 0.41; I^2 = 95%) or recovery (RR:1.49; 95% CI: 0.98–2.26; p = 0.06; I^2 = 91%). However, a sensitivity analysis excluding one short-term study revealed a significant recovery advantage for surgery at 5–6 months (RR: 1.70; 95% CI: 1.10–2.63; p = 0.02). Grading of Recommendations Assessment, Development, and Evaluation (GRADE) quality of evidence was ‘Very Low’ due to high heterogeneity and risk of bias.

Conclusion

Surgical intervention preliminarily hints at slightly better recovery rates compared to corticosteroid in the medium-to-long term. However, significant heterogeneity and the exploratory nature of these findings necessitate caution, and results are likely to change with the incorporation of future studies with different methodologies given the ‘Very Low’ GRADE rating for the quality of synthesised evidence. High-quality RCTs with standardised outcome definitions and longer follow-up benchmarks are required to establish definitive clinical guidelines.