SRS178 - Management of carpal tunnel syndrome: a network meta-analysis

Abstract Aim This network meta-analysis of randomised controlled trials (RCTs) compared the efficacy of various interventions for managing carpal tunnel syndrome (CTS). Methods As part of a broader umbrella review, we included all systematic reviews of RCTs focused on CTS management. The primary outcome was the Boston Carpal Tunnel Questionnaire (BCTQ), analysed through its two subscales: Symptom Severity Scale (SSS) and Functional Severity Scale (FSS). Interventions supported by at least two RCTs were included. Analyses were performed separately for short-term (≤12 weeks) and mid-term (13–52 weeks) outcomes. Surface under the cumulative ranking (SUCRA) curves ranked treatments, while treatment class tables summarised comparisons. The GRADE tool assessed the certainty of evidence, and both clinical and statistical significance were considered when comparing interventions. Results Of 113 eligible RCTs covering 66 interventions, 92 RCTs representing 16 interventions were included in the network meta-analyses. For CTS of any severity, corticosteroid injection with splinting ranked highest for short-term FSS, and endoscopic surgery for short-term SSS. At mid-term, extracorporeal shock wave therapy (ESWT) ranked highest for both SSS and FSS. In cases of mild-moderate CTS, platelet-rich plasma (PRP) injections ranked highest in the short term, while ESWT was most effective mid-term for both BCTQ subscales. Placebo or no treatment consistently ranked last. All interventions except splinting alone were superior to placebo at mid-term for CTS of any severity. Conclusions Non-surgical treatments, especially PRP and ESWT, show strong potential in managing CTS, particularly in mild to moderate cases. These findings support prioritising non-invasive approaches before considering surgery.