Carpal Tunnel Release Versus Local Corticosteroid Injection for Carpal Tunnel Syndrome: A Meta-Analysis of Randomized Controlled Trials.

Background: Carpal tunnel release (CTR) or local corticosteroid injection (LCI) is used for the management of carpal tunnel syndrome (CTS). While some practitioners start with CTR right away, others tend to begin with LCI. Both approaches are widely used, and individual randomized controlled trials (RCTs) have disagreed about the superiority of one approach over the other for CTS management. Therefore, a meta-analysis of RCTs would be helpful in informing clinicians. Methods: PubMed, Cochrane, and Google Scholar (pages 1-20) were searched up until August 8, 2025. Inclusion criteria consisted of English or non-English language RCTs comparing CTR with LCI in the management of CTS. The studied outcomes were management failure, improvement in symptoms, and improvement in function at several postoperative timepoints. Results: Twelve RCTs representing a total of 1799 patients, with 880 undergoing CTR and 919 undergoing LCI, were included. There was no difference in failure rates between the 2 groups at 1, 3, and 6 months; function improvement at 3 and 6 months; and symptoms improvement at 3 months. However, the LCI group had a higher rate of failure at 1 year (odds ratio [OR] = 18.41; p = 0.01) and latest follow-up (OR = 5.38; p = 0.003), and the CTR group had a better improvement in symptoms at 6 months (standardized means difference [SMD] = 0.39; p = 0.03) and 1 year (SMD = 0.30; p = 0.01). Conclusion: This meta-analysis revealed that CTR and LCI were equivalent management options for CTS for the first 6 months after treatment. However, CTR was superior at longer follow-up. Level of Evidence: Level I. See Instructions for Authors for a complete description of levels of evidence.