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World J Orthop. Jan 18, 2023; 14(1): 6-12
Published online Jan 18, 2023. doi: 10.5312/wjo.v14.i1.6
Update on surgical procedures for carpal tunnel syndrome: What is the current evidence and practice? What are the future research directions?
Valerio Pace, Fabrizio Marzano, Giacomo Placella
Valerio Pace, Department of Trauma & Orthopaedics, AOSP Terni - University of Perugia, Terni 05100, Italy
Fabrizio Marzano, Department of Trauma & Orthopaedics, University of Perugia, Perugia 06100, Italy
Giacomo Placella, Department of Trauma and Orthopaedics, IRCSS San Raffaele Hospital, Milan 20132, Italy
Author contributions: Pace V, Marzano F, and Placella G designed the article, performed research and literature review, analyzed data and wrote the review.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Valerio Pace, MBBS, Senior Postdoctoral Fellow, Surgeon, Department of Trauma & Orthopaedics, AOSP Terni - University of Perugia, Via Joannuccio, Terni 05100, Italy. valeriopace@doctors.org.uk
Received: September 20, 2022
Peer-review started: September 20, 2022
First decision: November 25, 2022
Revised: December 3, 2022
Accepted: December 21, 2022
Article in press: December 21, 2022
Published online: January 18, 2023
Processing time: 114 Days and 14.1 Hours
Abstract

Carpal tunnel syndrome (CTS) is a multifactorial compression neuropathy. It is reported to be very common and rising globally. CTS’s treatment varies from conservative measures to surgical treatments. Surgery has shown to be an effective method for more severe cases. However few unclear aspects and room for further research and improvements still remains. We performed a narrative literature review on the most up to date progress and innovation in terms of surgical treatments for CTS. The simple algorithm of leaving the choice of the surgical method to surgeons’ preference and experience (together with consideration of patients’ related factors) seem to be the best available option, which is supported by the most recent metanalysis and systematic reviews. We suggest that surgeons (unless in presence of precise indications towards endoscopic release) should tend to perform a minimally invasive open approach release, favoring the advantage of a better neurovascular structures visualization (and a consequent higher chance to perform a complete release with long term relief of symptoms) instead of favoring an early reduction (in the first postoperative days) of immobilization and pain. Research towards a universally accepted standardization should be aimed for by the researchers, who have failed to date to sufficiently limit bias and limitations.

Keywords: Carpal tunnel; Carpal tunnel release; Transverse ligament; Endoscopic release; Open release

Core Tip: After reviewing the most up to date literature, it could be said that evidence of superiority of one technique over the others is lacking from a high level of evidence point of view. Specific advantages and disadvantages of surgical methods can however be taken into account when choosing among treatments. The simple algorithm of leaving the choice of the surgical method to surgeons’ preference and experience (together with consideration of patients’ related factors) seem to be the best available option, which is supported by the most recent metanalysis and systematic reviews.