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To the Editor: Dr Gerritsen and colleagues¹ found that carpal tunnel release surgery produced better outcomes for patients with carpal tunnel syndrome (CTS) than did splinting. The authors excluded individuals with a history of wrist trauma, surgery, other medical conditions known to be associated with or to mimic CTS. However, they did include individuals with occupations that place them at risk for CTS. Because occupational exposure is the most common cause of CTS,² patients randomized to splint treatment may have had ongoing exposure to the cause of their CTS. By contrast, the group that received surgery could have been away from work for as long as 12 weeks. Modification of the ergonomic stressor is an integral part of the conservative management of CTS.

Margit L. Bleecker, MD, PhD
Center for Occupational and Environmental Neurology
Baltimore, Md

1. Gerritsen AAM, de Vet HCW, Scholten RJPM, Bertelsmann FW, de Krom MCTF, Bouter LM. Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomized controlled trial. JAMA. 2002;288:1245-1251. FREE FULL TEXT 2. Bernard BP, ed. Musculoskeletal Disorders and Workplace Factors: A Critical Review of Epidemiologic Evidence for Work-Related Musculoskeletal Disorders of the Neck, Upper Extremity and Low Back. Rockville, Md: US Dept of Health and Human Services; 1997:5A1-5A67. Publication 97-141.

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289:420.

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