Carpal tunnel release
Carpal tunnel release undertaken as an adjunct to surgery for acute injuries to the forearm
The median nerve runs down the arm and through a tunnel in the bones of the wrist where it becomes the main nerve to the thumb side of the hand. An injury to the forearm, the treatment of the injury or the pressure caused by later swelling can cause median nerve problems.
Carpal tunnel release (CTR) is a procedure to relieve pressure on the nerve as it passes through the tunnel. Opinions differ as to whether CTR should be done during operations for injuries to the forearm.
This review evaluated whether CTR during forearm surgery for acute injuries improved patient outcomes.
Some research studies are specifically designed to test whether a treatment is effective or not and the results are trustworthy. These studies are called high level evidence. Other studies are not designed to test the treatment, but just observe what happened to patients who received it or those who did not. These studies can provide some information, but it is not as certain as the information from high level evidence. These studies are referred to as low level evidence, sometimes called observational studies.
Eight relevant studies were found. Two studies compared patients who had CTR with patients who did not. The other six studies only included patients who had CTR. These six studies are low level evidence and in addition, they all had problems with the way they were run. This means that no definite conclusions can be made about whether doing a CTR at the same time as surgery for forearm injuries is a good idea or not.
All studies included patients with fractures to the forearm and in most studies the fracture was at the wrist end of the forearm bone. CTR was not found to benefit these patients, and one study found that patients who had CTR had a higher risk of developing median nerve problems.
In summary, there is weak evidence that patients are not helped by CTR done at the time of surgery for forearm injury, and may even be at risk of harm.