Role of Alpha-Lipoic Acid as a Co-adjuvant Treatment with Surgical Decompression of Carpal Tunnel Syndrome: A Retrospective Study.

Introduction: Surgical decompression remains the gold standard for managing severe carpal tunnel syndrome (CTS). However, perioperative pain and incomplete symptom resolution persist in some patients. Alpha-lipoic acid (ALA), a neuroprotective antioxidant, has shown potential benefits in neuropathic conditions. This retrospective study evaluates the clinical and electrophysiological effects of ALA as an adjunctive therapy in CTS management. Methods: We retrospectively analysed 164 patients with electrodiagnostically confirmed CTS who underwent open surgical decompression. Patients were divided into three groups: Group A (surgery only), Group B (surgery plus postoperative ALA) and Group C (pre- and postoperative ALA). Outcomes were assessed using the visual analogue scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), analgesic consumption and nerve conduction studies, with follow-up at 6 weeks, 6 months and 12 months. Results: ALA-treated patients showed statistically significant improvements in VAS scores, BCTQ subscales and analgesic consumption compared to controls. Only the group receiving both pre- and postoperative ALA achieved clinically meaningful improvements, exceeding the established MCID thresholds for both symptom severity (0.76 points) and functional status (0.32 points). Electrophysiological parameters, such as motor conduction velocity, also improved more in ALA-treated groups. Conclusions: Adjunctive use of ALA in CTS surgery was associated with statistically significant, yet clinically modest, improvements in pain, function and electrophysiology. These findings support further investigation of ALA as a low-risk, potentially beneficial coadjuvant in CTS treatment protocols. Level of Evidence: Level III (Therapeutic).