BMJ  2006;332:1463-1464 (24 June), doi:10.1136/bmj.332.7556.1463

Editorial

The diagnosis and treatment of carpal tunnel syndrome

Surgery—whether open or closed—works, but only if the diagnosis is right

The first 150 words of the full text of this article appear below.

The randomised controlled trial of Atroshi and colleagues (p 1473) in this week's BMJ shows that there are no substantive differences in the outcome of carpal tunnel syndrome treated with either a conventional open decompression of the median nerve or an endoscopic approach.¹ Their findings confirm those of earlier studies which also found no fundamental difference in outcome that could be attributed to the technique of surgical release of the carpal tunnel.^2-4

Given that the result of surgical treatment for carpal tunnel syndrome is not universally successful, however, what other factors might have an important impact on the outcome? One key determinant is probably the accuracy of the diagnosis.^{5 6} When the diagnosis is wrong treatment will fail no matter what it comprises while, as Atroshi and colleagues have shown, an accurate diagnosis is associated with success after adequate decompression by any means.

Standardised diagnostic criteria are lacking . . . [Full text of this article]

Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
(Brent.Graham@uhn.on.ca)

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