671 Comparative Efficacy and Safety of Different Modalities of Surgical Management of Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis

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Abstract Aim Carpal tunnel syndrome (CTS) is a prevalent condition caused by median nerve compression, leading to pain, numbness, and functional impairment. Surgical interventions, including open carpal tunnel release (OCTR), endoscopic carpal tunnel release (ECTR), and minimally invasive techniques, are widely used to relieve symptoms. This systematic review and meta-analysis evaluated the efficacy and safety of these surgical modalities. Method A systematic literature search was conducted across PubMed, Embase, and the Cochrane Central Register of Controlled Trials. The inclusion criteria focused on studies that reported on primary outcomes such as symptom severity and functional status. Data extraction was performed by two independent reviewers, and methodological quality was assessed using ROB 2 and the MINORS checklist. Results Eleven studies involving 834 participants met inclusion criteria. ECTR showed the greatest improvement in Boston Carpal Tunnel Questionnaire Symptom Severity Score (2.30) and Functional Status Score (1.80) at three months. Mini-open carpal tunnel release (Mini-OCTR) demonstrated the least improvement (SSS: 1.34, FSS: 0.71). Ultrasound-guided carpal tunnel release (CTR-US) had the most substantial improvement in Disabilities of the Arm, Shoulder, and Hand (DASH) scores (47.05), while Mini-OCTR had the least (39.21). Pain reduction (VAS scores) was highest with ECTR (5.79) compared to Mini-transverse incision CTR (3.50). Complication rates varied, with CTR-US having the lowest (0.01) and OCTR the highest (0.30). Conclusions Different surgical approaches for CTS provide symptom relief and functional improvement, but results vary. Surgical decisions should consider patient-specific factors and surgeon expertise. Further research is needed to address study heterogeneity and long-term outcomes.

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