A recent study published in the British Medical Journal took a look at evidence for 10 of the most commonly performed orthopedic surgeries. The study was focused on the quality of evidence that has been published in support of the most common elective surgeries in the orthopedic field. The results were surprising to a lot of people.
When the researchers reviewed the studies, they found that nine out of 10 of the most common orthopedic surgeries had no evidence or weak evidence to support their use over conservative care or a sham surgery. This included common procedures like rotator cuff surgery, meniscus surgery and lumbar decompression surgery. However, there was one surgical intervention that did show good evidence for its use: carpal tunnel release surgery.
Why Does Carpal Tunnel Release Have Better Evidence Than Other Orthopedic Surgeries?
First let’s take a moment to talk about Carpal Tunnel Syndrome (CTS) and the relevant anatomy. The Carpal Tunnel is ostensibly a choke point in the wrist that the median nerve and nine other tendons pass through on the way to the hand. At this choke point, the median nerve can become compressed by the transverse carpal ligament that makes up the roof of the carpal tunnel and the other tendons that travel through this space. When this happens, CTS can develop where the patient experiences numbness and tingling in the hands and wrist. These symptoms are often worse at night and worse with repetitive activity. Over time, these symptoms usually worsen and can lead to permanent weakness in the hands.
Fortunately, Carpal Tunnel release can actually prevent weakness in the hands from developing in the vast majority of patients with CTS. This is why the evidence for this elective orthopedic intervention is good: Those that get the surgery tend to do better long-term vs those that don’t because of the permanent weakness that can develop. Obviously, if you have CTS or suspect that you do, a thorough evaluation and explanation of all of the available options is paramount when creating a treatment plan.