Efficacy of Surgery versus Corticosteroids for Carpal Tunnel Syndrome: A GRADE-Assessed Systematic Review and Meta-analysis of Randomised Controlled Trials

Published Date: 07th May 2026

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Introduction
Carpal Tunnel Syndrome (CTS) is the most prevalent entrapment neuropathy. While surgical decompression and local corticosteroid injections are established treatments, their relative long-term efficacy remains debated. This meta-analysis evaluates the comparative efficacy of surgery versus corticosteroid injections, incorporating the recent large-scale DISTRICTS trial.

Methods and Materials
Following PRISMA guidelines, we searched PubMed, Cochrane Library, Scopus, and Embase through December 20, 2025, for randomised controlled trials (RCTs) comparing surgery to corticosteroid injections. Primary outcomes included patient recovery (Risk Ratio [RR]) and mean symptom severity (Standardised Mean Difference [SMD]). Meta-analysis was performed using a random-effects model, and evidence quality was assessed via the GRADE scale.

Results
Seven RCTs involving 1,463 wrists were included. Initial pooled analysis showed no significant difference between surgery and corticosteroid injections in post-procedural symptom severity (SMD: −0.55; 95% CI: −1.85–0.76; p = 0.41; I^2 = 95%) or recovery (RR:1.49; 95% CI: 0.98–2.26; p = 0.06; I^2 = 91%). However, a sensitivity analysis excluding one short-term study revealed a significant recovery advantage for surgery at 5–6 months (RR: 1.70; 95% CI: 1.10–2.63; p = 0.02). Grading of Recommendations Assessment, Development, and Evaluation (GRADE) quality of evidence was ‘Very Low’ due to high heterogeneity and risk of bias.

Conclusion
Surgical intervention preliminarily hints at slightly better recovery rates compared to corticosteroid in the medium-to-long term. However, significant heterogeneity and the exploratory nature of these findings necessitate caution, and results are likely to change with the incorporation of future studies with different methodologies given the ‘Very Low’ GRADE rating for the quality of synthesised evidence. High-quality RCTs with standardised outcome definitions and longer follow-up benchmarks are required to establish definitive clinical guidelines.

Malik, A; Shaikh, A et al. (2026). Efficacy of Surgery versus Corticosteroids for Carpal Tunnel Syndrome: A GRADE-Assessed Systematic Review and Meta-analysis of Randomised Controlled Trials. Indian Journal of Orthopaedics. Pub online 07 May. [Online]. Available at: https://doi.org/10.1007/s43465-026-01793-3 [Accessed 27 May 2026]