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January 22/29, 2003

Splinting vs Surgery for Carpal Tunnel SyndromeSplinting vs Surgery for Carpal Tunnel Syndrome

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(4):420-423. doi:10.1001/jama.289.4.420-a

To the Editor: In the study by Dr Gerritsen and colleagues,1 several patients from the splinting group underwent surgery before completing the 18-month follow-up even though the trend of success was increasing for the splint group and decreasing (after 6 months) for the surgery group. In addition, only 31% received custom splints, which are known to yield higher compliance and better results.2 It is likewise noteworthy that the splint protocol was only for nighttime use, which has been demonstrated to be less effective than full-time wear.3 Comparison of splints to surgery is a futile effort. It might be appropriate to compare surgery with steroid injection, or with a combination of conservative methods, but not to splinting in isolation. A typical treatment plan for CTS applies a multifaceted approach, including anti-inflammatory medication with splinting, in addition to various forms of physical therapy, exercises, and manipulation.4