Wrist Immobilization after Surgical Decompression of the Median Nerve in Carpal Tunnel Syndrome: A Systematic Review.

Abstract

<b>Objective</b>  The most common compressive neuropathy of the upper limbs is carpal tunnel syndrome (CTS). Historically, there has been a tendency to apply immobilization in the postoperative period, a practice that has decreased in recent years. This review aims to assess whether there is scientific evidence to justify the use of immobilization in the postoperative care of CTS decompression. <b>Methods</b>  The following databases were used: Biblioteca Virtual em Saúde (BVS), PubMed National Library of Medicine - (NLM), Cochrane Library, Scientific Electronic Library Online (SciELO), and EMBASE. The following inclusion criteria were used: 1) discussion of the postoperative period of median nerve decompression surgery in CTS; 2) comparison of results after surgical decompression in CTS between wrist immobilization or local dressing; 3) all languages, regardless of the year of publication; and 4) all types of publications. The following exclusion criteria were used: 1) studies that did not evaluate the postoperative period of CTS decompression; 2) lack of evaluation of the outcome related to the application of local dressing or some form of wrist immobilization after the surgical decompression procedure; and 3) repeated publications. <b>Results</b>  The literature search resulted in 336 relevant publications. In the end, 18 publications were chosen. Systematic reviews, randomized clinical trials, and cross-sectional studies were found. <b>Conclusions</b>  Due to the scarcity of evidence supporting the use of immobilization coupled with the higher costs associated with the practice, it has become less and less frequent in recent decades. <b>Clinical relevance</b>  In the literature, two approaches to postoperative care for CTS decompression are described: immobilization or just local dressing. According to the available scientific evidence, it is worth evaluating which one is better.