Carpal tunnel syndrome: one flew over the surgeon’s nest. The Cochrane Neurological Network

Abstract

The Cochrane Collaboration is an international non-profit and independent organization, dedicated to making up-to-date, accurate information about the effects of healthcare readily available worldwide. It produces and disseminates systematic reviews of healthcare interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. The major product of the Collaboration is the Cochrane Database of Systematic Reviews which is published quarterly as part of The Cochrane Library. A systematic review, when well done, is a reliable summary of the body of knowledge at the time. Its result may mean that one has to temper one’s opinion of the value of a particular treatment but there is no place nowadays for ineffective or hazadous treatments. Systematic reviews should be looked upon as extremely useful sorting tools to get a better perspective of current status of knowledge, and looked to see what questions new trials should seek to answer in future. This is the case of the reviews on the treatment of Carpal Tunnel Syndrome (CTS). On October 26, 2002, in Corciano, the Cochrane Neurological Network organised its 2^nd Multidisciplinarian Workshop to discuss Cochrane systematic reviews on th e treatment of CTS. A variety of experts participated in the presentation, including neurologists and orthopaedic hand surgeons of different backgrounds. The main outcome of the meeting was to capture the current state of knowledge on CTS by looking back at evidence from sistemtic reviews and their single trials. Secondary outcome of the meeting was determined that it is necessary to favor controlled clinical studies on the disease correcting for the drawbacks highlighted in previous studies. Such corrections should include specific diagnostic criteria of the CTS; a larger sample size of the single trials; suitable follow up; subgroup division by age, sex, and clinically and instrumentally determined severity of the disease; duration of the disease; and degree of stressful activity.

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