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The traditional clinical approach to carpal tunnel syndrome (CTS) management is largely dependent on symptom severity. Patients with milder symptoms are treated with nonoperative therapies, such as splinting or steroid injection, and those with more-severe symptoms receive surgical decompression. However, we don't have good comparative evidence about these two initial approaches.
In this multicenter, randomized Dutch trial, 934 participants with CTS (of various severities) received either initial surgical decompression or corticosteroid injections; all cases were confirmed by electrophysiologic or sonographic testing. Additional therapies (both surgical and injection) were allowed after the initial treatment. Symptom recovery (no symptoms or…