The comparison of limited-incision versus standard-incision in treatment of carpal tunnel syndrome: A meta-analysis of randomized controlled trials

BACKGROUND: Carpal tunnel syndrome is a common compressive neuropathy of the median nerve. Compared with standard release, the efficacy, safety, and postoperative complications of limited carpal tunnel release remain controversial. The purpose of this study was to compare the effects of the 2 treatments. METHODS: The English-language literature was searched using MEDLINE, Web of Science, and Embase. Randomized controlled trials that compared standard and limited incision for carpal tunnel release were included in the meta-analysis. Strength, interval to return to activities, the rate of adverse events, effectiveness, and operative time were compared. RESULTS: Thirteen randomized controlled trials (RCTs) containing 1020 patients were included. Limited incision treated patients showed better early recovery of grip strength (mean difference [MD], 4.25 [0.86–7.65]; P = .01) and pinch strength (MD, 1.37 [0.24–2.51]; P = .02) but no advantage after more than 6 months. Patients treated with limited incision showed an earlier return to activities (MD,−8.80 [−9.21 to −8.39]; P < .01) and reduced operative time (standardized mean difference [SMD], −1.68 [−3.24 to−0.12]; P = .04). The rate of adverse event was significantly higher in standard group compared with that in limited group (risk ratio [RR] 0.61, 95% CI 0.38–0.96, P = .03). CONCLUSIONS: Limited incision release allows us to return to activities early, reduces operative time, decreases rate of adverse events, and improves strength during the early postoperative period. Results at 6 months or longer are similar according to current data. However, the results of this meta-analysis should be interpreted with caution due to heterogeneity amongst the included studies.