Surgery—whether open or closed—works, but only if the diagnosis is right

The randomised controlled trial of Atroshi and colleagues (p 1473) in this week's BMJ shows that there are no substantive differences in the outcome of carpal tunnel syndrome treated with either a conventional open decompression of the median nerve or an endoscopic approach.1 Their findings confirm those of earlier studies which also found no fundamental difference in outcome that could be attributed to the technique of surgical release of the carpal tunnel.2^–4

Given that the result of surgical treatment for carpal tunnel syndrome is not universally successful, however, what other factors might have an important impact on the outcome? One key determinant is probably the accuracy of the diagnosis.5 6 When …