Poor outcome for neural surgery (epineurotomy or neurolysis) for carpal tunnel syndrome compared with carpal tunnel release alone: a meta-analysis of global outcomes.

A meta-analysis was performed on the results of eight studies that compared the global outcomes of patients who received carpal tunnel release with the global outcomes of patients who received carpal tunnel release and neurolysis or epineurotomy. The meta-analysis suggests that patients who received such neural surgery tended to have poorer global outcomes than those who did not (odds ratio, 0.54; 95 percent confidence interval, 0.32 to 0.90). The data are homogenous, and linear-regression analysis indicates that patient attrition did not influence the outcome of the meta-analysis. The results of this meta-analysis indicate that neural surgery is potentially harmful for most patients with carpal tunnel syndrome. The possibility remains that neural surgery may be helpful in special cases, such as in the presence of marked scarring or neural adhesion, but no available evidence specifically documents the benefits and harms of surgery among such patients.