Local steroid injection better than surgery for carpal tunnel syndrome
from Medscape Medical News
by Laurie Barclay, MD
Feb. 3, 2005 — Local steroid injection initially may be better than surgery for carpal tunnel syndrome (CTS), according to the results of the first randomized trial published in the February issue of Arthritis & Rheumatism. At three months, symptomatic relief was better with injection; by six months, surgery was not statistically significantly better; and at one year, both treatments were equally effective.
"Local injection of corticosteroids is usually recommended for patients who remain symptomatic after conservative treatment with splinting and nonsteroidal antiinflammatory drug [NSAID] therapy," write Domingo Ly-Pen, MD, from Primary Care Unit Gandhi in Madrid, Spain, and colleagues. "Surgical treatment is widely preferred over nonsurgical or conservative therapies for severe CTS, since this condition can cause partial paralysis of the thumb and permanent loss of sensation. In contrast, mild cases of CTS are usually not treated."
In this one-year, prospective, open trial, of 101 patients with a clinical and neurophysiologic diagnosis of CTS, 163 wrists were randomized to surgical decompression or local steroid injection. Clinical evaluations were performed at baseline and at 3, 6, and 12 months after treatment. The primary outcome was the percentage of wrists that reached a 20% or more improvement in the visual analog scale (VAS) score for nocturnal paresthesias at three months, and analysis was by intent-to-treat.
At baseline, severity of CTS was comparable in both groups. At three months of follow-up, 94.0% of the wrists in the steroid injection group and 75.0% in the surgery group reached the primary endpoint (P = .001). The corresponding percentages were 85.5% vs 76.3% (P = .16) at six months and 69.9% vs 75.0% (P = 0.49) at 12 months.
Study limitations include lack of double blinding, need for two injections in most injected wrists, lack of formal validation of the outcomes measurements, and randomization based on wrists instead of patients.
"Over the short term, local steroid injection is better than surgical decompression for the symptomatic relief of CTS," the authors write. "At one year, local steroid injection is as effective as surgical decompression for the symptomatic relief of CTS.... An explanation for this may be that, in the short term, local steroid injections produce dramatic relief of symptoms, but the surgical incision may still be painful because of scarring and local inflammation."
Arthritis Rheumat. 2005;52:612-619
by Laurie Barclay, MD
Feb. 3, 2005 — Local steroid injection initially may be better than surgery for carpal tunnel syndrome (CTS), according to the results of the first randomized trial published in the February issue of Arthritis & Rheumatism. At three months, symptomatic relief was better with injection; by six months, surgery was not statistically significantly better; and at one year, both treatments were equally effective.
"Local injection of corticosteroids is usually recommended for patients who remain symptomatic after conservative treatment with splinting and nonsteroidal antiinflammatory drug [NSAID] therapy," write Domingo Ly-Pen, MD, from Primary Care Unit Gandhi in Madrid, Spain, and colleagues. "Surgical treatment is widely preferred over nonsurgical or conservative therapies for severe CTS, since this condition can cause partial paralysis of the thumb and permanent loss of sensation. In contrast, mild cases of CTS are usually not treated."
In this one-year, prospective, open trial, of 101 patients with a clinical and neurophysiologic diagnosis of CTS, 163 wrists were randomized to surgical decompression or local steroid injection. Clinical evaluations were performed at baseline and at 3, 6, and 12 months after treatment. The primary outcome was the percentage of wrists that reached a 20% or more improvement in the visual analog scale (VAS) score for nocturnal paresthesias at three months, and analysis was by intent-to-treat.
At baseline, severity of CTS was comparable in both groups. At three months of follow-up, 94.0% of the wrists in the steroid injection group and 75.0% in the surgery group reached the primary endpoint (P = .001). The corresponding percentages were 85.5% vs 76.3% (P = .16) at six months and 69.9% vs 75.0% (P = 0.49) at 12 months.
Study limitations include lack of double blinding, need for two injections in most injected wrists, lack of formal validation of the outcomes measurements, and randomization based on wrists instead of patients.
"Over the short term, local steroid injection is better than surgical decompression for the symptomatic relief of CTS," the authors write. "At one year, local steroid injection is as effective as surgical decompression for the symptomatic relief of CTS.... An explanation for this may be that, in the short term, local steroid injections produce dramatic relief of symptoms, but the surgical incision may still be painful because of scarring and local inflammation."
Arthritis Rheumat. 2005;52:612-619
posted by Ricardo Pocurull at 7:05 AM
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