***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Splinting of the wrist after carpal tunnel release ( CTR ) has been practised by many surgeons especially in North America . The main reason was to prevent possible adverse events of bowstringing of flexor tendons and the median nerve , pillar pain , entrapment of the median nerve in scar tissue and wound dehiscence . Studies on the effect of splinting after st and ard CTR have had dismal results . The duration of splinting in st and ard CTR has been either too long ( for 2 - 4 weeks ) or too short ( 48 hours only ) . The aim of our study was to compare the effects of post-operative splinting for a duration of one week with no splinting . Methods : All 30 of our patients underwent a st and ardized limited open CTR by a design ated surgeon . Post operatively , they were r and omized into a splinted  ( n=16 ) and a nonsplinted  ( n=14 ) group . The splint was kept for a week . Patients were review ed at regular intervals of one week , two months and six months . At each follow up , these patients were clinical ly assessed for the following outcome measures : VAS ( visual analogue score ) , 2PD ( two-point discrimination ) , pinch grip , grip , Abductor Pollicis Brevis ( APB ) ) power and completion of the Boston question naire . Results : All patients presented with significant improvement in the postoperative evaluation in the analyzed parameters within each group . However , there was no significant difference between the two groups for any of the outcome measurements at sequential and at final follow-up . Conclusion : We conclude that wrist splinting in the immediate post-operative period has no advantage when compared with the unsplinted wrist after a limited open carpal tunnel release OBJECTIVE To compare the effects of coronal Z-type lengthening of transverse carpal ligament with conventional open approach for carpal tunnel syndrome . METHODS A double-blinded study was conducted from January 2005 to August 2008 on 68 patients with a mean age of 41 years ( range 27 - 55 years ) diagnosed as severe carpal tunnel syndrome . They were r and omized into two groups(A and B ) . Patients in group A underwent coronal Z-type lengthening of transverse carpal ligament ; and patients in group B had conventional open approach surgery . Postoperative evaluation was scheduled at 1 , 3 , 6 and 12 months after the surgery and incidence rate of bowstring of the flexor tendons , improvement of grip strength and ADL activities of daily living ) score were recorded . RESULTS Fifty-eight patients had been followed up successfully , 30 and 28 for group A and B respectively . The Scar Tissue Formation of the flexor tendons in group B was observed more than that in group A at 6 and 12 month after operation . Improvement of grip strength were observed in two groups , which was statistically different between 6 and 12 months after operation and no significant difference was seen between 1 and 3 months after operation . According to ADL , the satisfaction rates documented on form for patients were statistically different in the two groups at 6 and 12 months after operation and no difference was noted at 1 and 3 months after operation . CONCLUSION Excellent improvement of function and satisfaction were achieved by Coronal Z-type reconstruction of the flexor retinaculum for severe carpal tunnel syndrome . Our method offers a more effective alternative method for conventional carpal tunnel open decompression surgery CONTEXT Carpal tunnel syndrome ( CTS ) can be treated with nonsurgical or surgical options . However , there is no consensus on the most effective method of treatment . OBJECTIVE To compare the short-term and long-term efficacy of splinting and surgery for relieving the symptoms of CTS . DESIGN , SETTING , AND PATIENTS A r and omized controlled trial conducted from October 1998 to April 2000 at 13 neurological outpatient clinics in the Netherl and s. A total of 176 patients with clinical ly and electrophysiologically confirmed idiopathic CTS were assigned to wrist splinting during the night for at least 6 weeks ( 89 patients ) or open carpal tunnel release ( 87 patients ) ; 147 patients ( 84 % ) completed the final follow-up assessment 18 months after r and omization . MAIN OUTCOME MEASURES General improvement , number of nights waking up due to symptoms , and severity of symptoms . RESULTS In the intention-to-treat analyses , surgery was more effective than splinting on all outcome measures . The success rates ( based on general improvement ) after 3 months were 80 % for the surgery group ( 62/78 patients ) vs 54 % for the splinting group ( 46/86 patients ) , which is a difference of 26 % ( 95 % confidence interval [ CI ] , 12%-40 % ; P<.001 ) . After 18 months , the success rates increased to 90 % for the surgery group ( 61/68 patients ) vs 75 % for the splinting group ( 59/79 patients ) , which is a difference of 15 % ( 95 % CI , 3%-27 % ; P = .02 ) . However , by that time 41 % of patients ( 32/79 ) in the splint group had also received the surgery treatment . CONCLUSION Treatment with open carpal tunnel release surgery result ed in better outcomes than treatment with wrist splinting for patients with CTS Background This study analyzes both the subjective and objective symptom and functional outcomes of patients who underwent either traditional single-incision or two-incision carpal tunnel release ( CTR ) .  Methods From 2008 to 2009 , patients with isolated carpal tunnel syndrome were r and omized to undergo either single-incision or two-incision CTR by a single surgeon at a university medical center . Pre-operatively , participants completed a Disabilities of the Arm , Shoulder , and H and ( DASH ) Question naire , Brigham and Women 's Carpal Tunnel Question naire ( BWCTQ ) , as well as grip and pinch strength and Semmes – Weinstein monofilament sensation testing . At 2 weeks , 6 weeks and at least 6 months post-operatively , these measurements were repeated along with assessment of scar tenderness and pillar pain . Data were analyzed using SPSS version 20 software to perform non-parametric tests and Pearson 's correlations . Significance was set at p = 0.05 . Results There was no statistically significant difference between the single- and two-incision CTR groups with respect to pre- and post-operative DASH scores , BWCTQ scores , grip strength , pinch strength , scar tenderness , or pillar pain . The only statistically significant difference was improved sensation by Semmes – Weinstein in the single-incision group in the second finger at 6 weeks post-operatively and in the third finger at 6 months post-operatively . Conclusions The preservation of the superficial nerves and subcutaneous tissue between the thenar and hypothenar eminences may account for reports of less scar tenderness and pillar pain among recipients of two-incision CTR compared to single-incision CTR in the early post-operative period . However , there is similar post-operative recovery and improvement in grip and pinch strength and sensation after 6 + months post-operatively A prospect i ve , r and omized study was performed on twenty patients with bilateral carpal tunnel syndrome . Each patient had  traditional open surgery  on one side and single portal endoscopic release  on the other . Follow-up examinations were undertaken at two , four , and twelve weeks and at eight months . The period between the two operative procedures was meanly three months ( two to four months ) . The dominant h and was released endoscopically according to Agee in eleven cases and the non-dominant h and in nine cases . Sixteen out of twenty patients preferred the endoscopic release . Complications did not occur more frequently in patients operated endoscopically . The preoperative symptoms were relieved equally in both groups . Return to work or leisure activities was earlier in the endoscopic collective ( 20 days ) in contrast to 30 days in the traditional operated group We report a new surgical technique of open carpal tunnel release with subneural reconstruction of the transverse carpal ligament and compare this with isolated open and endoscopic carpal tunnel release .  Between December 2007 and October 2011 , 213 patients with carpal tunnel syndrome ( 70 male , 143 female ; mean age 45.6 years ; 29 to 67 ) were recruited from three different centres and were r and omly allocated to three groups : group A , open carpal tunnel release with subneural reconstruction of the transverse carpal ligament ( n = 68 ) ; group B , isolated open carpal tunnel release ( n = 92 ) ; and group C , endoscopic carpal tunnel release ( n = 53 ) . At a mean final follow-up of 24 months ( 22 to 26 ) , we found no significant difference between the groups in terms of severity of symptoms or lateral grip strength . Compared with groups B and C , group A had significantly better functional status , cylindrical grip strength and pinch grip strength . There were significant differences in Michigan H and Outcome scores between groups A and B , A and C , and B and C. Group A had the best functional status , cylindrical grip strength , pinch grip strength and Michigan H and Outcome score .  Subneural reconstruction of the transverse carpal ligament during carpal tunnel decompression maximises h and strength by stabilising the transverse carpal arch A 10-center r and omized prospect i ve multicenter study of endoscopic release of the carpal tunnel was carried out . Surgery was performed with a new device for transecting the transverse carpal ligament while control h and s were treated with conventional open surgery . There were 122 patients in the study ; 25 had carpal tunnel surgery on both h and s and 97 had surgery on one h and . Of the surgical procedures , 65 were in the  control  group and 82 were in the device group . The endoscopic device was coupled to a fiberoptic light and a video camera . A trigger-activated blade was used to incise the transverse carpal ligament . After surgery , the best predictors of return to work and to activities of daily living were strength and tenderness variables . For patients in the device group with one affected h and , the median time for return to work was 21 1/2 days less than that for the control group . Two patients treated with the endoscopic device required reoperation by open surgical decompression ; only one of these had incomplete release with the device . Two patients in the device group experienced transient ulnar neurapraxia AIM To compare a limited palmar incision for carpal tunnel release ( CTR ) with a traditional open technique , which is still considered the gold st and ard . METHODS Seventy-two patients with a carpal tunnel syndrome were individually r and omized into the trial ( limited incision CTR ) ( n=36 ) and control group ( traditional technique CTR ) ( n=36 ) . In the trial group , skin incision parallel to the thenar crease was made up to 2.5 cm in length , under an operating microscope and endoscopic transillumination . Skin incision in the control group began at the distal border of the carpal ligament , followed the longitudinal crease of the palm , and crossed the base of the palm in a zigzag fashion . Three months after surgery , the patients were asked about symptomatic relief and intervals between the operation and return to their daily activities and work , and examined for scar tenderness and esthetic outcome . Distal motor latency , conduction velocity , scar length , scar width , and operation time were measured . RESULTS There were no differences between the two groups in symptomatic relief and electrophysiological parameters . Intervals between the operation and return to daily activities ( median 5 days , range 2 - 15 ) were shorter in the trial group than in the control group ( median 10 days , range 2 - 21 ; p<0.001 ) , as well as the intervals between the operation and return to work ( median 15 days , range 5 - 45 vs median 30 days , range 10 - 60 ; p<0.001 ) . Scar/pillar tenderness , scar length and width , esthetic outcome , and operation time were significantly better in the trial group . CONCLUSION Limited palmar incision CTR is as effective and safe as traditional CTR technique , but with better postoperative recovery and cosmetic results OBJECTIVE To compare outcomes of patients undergoing either open or endoscopic carpal tunnel release for the treatment of idiopathic carpal tunnel syndrome . METHODS A prospect i ve , r and omized study was performed on 70 h and s in 62 patients with idiopathic carpal tunnel syndrome from April 2000 to April 2004 . Either open ( 36 h and s in 30 patients ) or endoscopic ( 34 h and s in 32 patients ) carpal tunnel release was performed r and omly . Symptom improvement , complications , and the time of operation , in-hospital stay , and return to work between the two groups were assessed with average 2 years of follow-up . The  electromyography  was tested pre- and 3 months post-operation . RESULTS There were no significant differences between the two surgical groups with regard to postoperative improvements of symptom , electromyography tests , and the incidence of complications . But it was statistically less in the rate of scar tenderness , the time of operation , in-hospital stay , and return to work in the endoscopic group compared with the open group ( P < 0.05 ) . CONCLUSIONS The endoscopic carpal tunnel release is a reliable method in the treatment of idiopathic carpal tunnel syndrome . And it has the advantages of slight scar tenderness , less operation time , less in-hospital stay , early functional recovery , safety , and high- satisfaction rate compared with open methods Endoscopic carpal tunnel release has the advantage over open release of reduced tissue trauma and postoperative morbidity . Limited open carpal tunnel release has also been shown to have comparable results , but is easier to perform and is safer . We have compared the 
    Output:
    
Corticosteroid injection was more effective than surgery ( strong evidence , short-term ) .
Surgery was more effective than splinting or anti-inflammatory drugs plus h and therapy ( moderate evidence , midterm and long-term ) .
Manual therapy was more effective than surgical treatment ( moderate evidence , short-term and midterm ) .
Within surgery , corticosteroid irrigation of the median nerve before skin closure as additive to CTS release or the direct vision plus tunneling technique was more effective than st and ard open CTS release ( moderate evidence , short-term ) .
Furthermore , short was more effective than long bulky dressings , and a sensory retraining program was more effective than no program after surgery ( moderate evidence , short-term ) .
Surgical treatment seems to be more effective than splinting or anti-inflammatory drugs plus h and therapy in the short-term , midterm , and /or long-term to treat CTS .
However there is strong evidence that a local corticosteroid injection is more effective than surgery in the short-term , and moderate evidence that manual therapy is more effective than surgery in the short-term and midterm .
There is no unequivocal evidence that suggests one surgical treatment is more effective than the other .
Postsurgical , a short- ( 2 - 3 days ) favored a long- duration ( 9 - 14 days ) bulky dressing and a sensory retraining program seems to be more effective than no program in short-term .