A novel approach of local corticosteroid injection for the treatment of carpal tunnel syndrome. Local vs systemic corticosteroids in the treatment of carpal tunnel syndrome. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. Evaluation of iontophoresis and local corticosteroid injection in the treatment of carpal tunnel syndrome. The comparison of ultrasound treatment and local steroid injection plus splinting in the carpal tunnel syndrome: a randomized controlled trial. Single vs. two steroid injections for carpal tunnel syndrome: a randomised clinical trial. Corticosteroid injection for the treatment of carpal tunnel syndrome. Corticosteroid injection vs. nonsteroidal antiinflammatory drug and splinting in carpal tunnel syndrome. Surgical decompression versus local steroid injection in carpal tunnel syndrome: a one-year, prospective, randomized, open, controlled clinical trial. The efficacy of local steroid injections in idiopathic carpal tunnel syndrome: a double-blind study. Oral drug of choice in carpal tunnel syndrome.
The objective of the study was to compare the favorable response rate, time duration, and pain level of local corticosteroid injection using a novel approach for the treatment of carpal tunnel syndrome vs a classic approach. Patients with symptomatic carpal tunnel syndrome of less than 1-year duration were randomized for local corticosteroid injection using either the classic approach or a novel approach. In our approach (novel), we used a 29 gauge x 1/2-in. needle and a 1-ml insulin syringe containing 12 mg of methylprednisolone mixed with 0.15 ml of lidocaine 2%, and the site of the injection was 2-3 cm distal to the middle of wrist crease. In the classic approach, we used a 25 gauge x 3-cm needle and a 2-ml syringe injecting 35 mg of methylprednisolone mixed with 0.5 ml of lidocaine 2%, 3-4 cm proximal to the wrist crease and just ulnar to the tendon of the flexor carpi radialis muscle. Response rate was evaluated 1, 3, 6, and 12 weeks after the injection, and also the duration of time of the procedure and the level of pain using the visual analogue scale were compared between the two groups. Forty-two patients signed the consent form, and all of them completed the study [21 patients in the classic approach group (group 1) and 21 patients in the novel approach group (group 2)]. The favorable response rates were 100, 81, 71, and 57% in group 1 and 100, 71, 67, and 57% in group 2 after 1, 3, 6, and 12 weeks, respectively. There was no significant difference in the favorable response rate between the two groups (p=0.468, 95% CI=-12-31%, after 3 weeks). The average duration of time of the procedure in group 1 was 26.71+/-32.83 s compared to 8.48+/-1.123 s (p=0.021) in group 2. The average grade of pain expressed by the patients in group 1 was 4.38+/-1.523 compared to 3.62+/-1.071 in group 2 (p=0.065). In conclusion, local corticosteroid injection using the novel approach for the treatment of carpal tunnel syndrome is helpful, and the favorable response rates are comparable to those using the classic approach after 1, 3, 6, and 12 weeks. The novel approach is much less time consuming and is not more painful. The authors compared the effectiveness of low-dose, short-term oral prednisolone vs local methylprednisolone injection in a prospective, double-blinded, parallel treatment study of carpal tunnel syndrome (CTS). A single injection of 15 mg methylprednisolone resulted in significant improvement in global symptom scores over a 12-week period. This study demonstrated the superiority of local steroid injection to oral steroid in the treatment of CTS. Decompressive surgery and steroid injection are widely used forms of treatment for carpal tunnel syndrome (CTS) but there is no consensus on their effectiveness in comparison to each other. The authors evaluated the efficacy of surgery vs steroid injection in relieving symptoms in patients with CTS.
                The authors conducted a randomized, single blind, controlled trial. Fifty patients with electrophysiologically confirmed idiopathic CTS were randomized and assigned to open carpal tunnel release (25 patients) or to a single injection of steroid (25 patients). Patients were followed up at 6 and 20 weeks. The primary outcome was symptom relief in terms of the Global Symptom Score (GSS), which rates symptoms on a scale of 0 (no symptoms) to 50 (most severe). Nerve conduction studies and grip strength measurements were used as secondary outcome assessments.
                At 20 weeks after randomization, patients who underwent surgery had greater symptomatic improvement than those who were injected. The mean improvement in GSS after 20 weeks was 24.2 (SD 11.0) in the surgery group vs 8.7 (SD 13.0) in the injection group (p < 0.001); surgical decompression also resulted in greater improvement in median nerve distal motor latencies and sensory nerve conduction velocity. Mean grip strength in the surgical group was reduced by 1.7 kg (SD 5.1) compared with a gain of 2.4 kg (SD 5.5) in the injection group.
                Compared with steroid injection, open carpal tunnel release resulted in better symptomatic and neurophysiologic outcome but not grip strength in patients with idiopathic carpal tunnel syndrome over a 20-week period. The aim of this study was to compare the efficacy of local corticosteroid injection with iontophoresis of corticosteroids in the treatment of carpal tunnel syndrome.
                This study was a prospective, randomized, unblinded clinical trial with follow-up at 2 and 8 wks. Thirty patients (48 median nerves) with clinical and electrophysiologic evidence of carpal tunnel syndrome were included in the study. Patients were evaluated by use of clinical variables, a functional status scale, a symptom severity scale, and visual analog scale. A total of 48 median nerves were randomly assigned to one of two groups; group 1 received 40 mg of methylprednisolone acetate injected locally in the carpal tunnel, and group 2 received iontophoresis of dexamethasone sodium phosphate. Clinical variables and scales were evaluated at regular intervals: at the beginning and at the end of therapy in the second and eighth week.
                Twenty-seven patients (90%) were women and three patients (10%) were men. The mean age of patients was 48.0 +/- 8.2 (range, 29-61) yrs. There was a statistically significant improvement in the clinical examination variables, visual analog scale, symptom severity scale, and functional status scale scores of the patients in both of the treatment groups posttreatment (at 2 and 8 wks) compared with baseline (P < 0.05). However, there was a statistically significant difference between the values of the two group. A significant difference in mean symptom severity scale, functional status scale, and visual analog scale scores was found in second week and eighth week in the injection group compared with iontophoresis.
                Our study comparing a standardized treatment protocol for incorporating local corticosteroid injection and iontophoresis of dexamethasone sodium phosphate in carpal tunnel syndrome revealed success of both iontophoresis of dexamethasone sodium phosphate and injection of corticosteroids, but symptom relief was greater at 2 and 8 wks with injection of corticosteroids. This study aimed to compare the efficacy of ultrasound treatment to local corticosteroid injection plus splinting in carpal tunnel syndrome (CTS). There is still limited knowledge on the efficacy of conservative treatment options for CTS.
                Fourty-nine hands of 34 patients with CTS were enrolled in this study. Patients were randomly assigned to the ultrasound treatment (group A) or local corticosteroid injection plus splinting (group B). The primary outcome measures included clinical parameters such as symptoms severity score, visual analogue scale (VAS) pain, functional status score, grip strength and two-point discrimination. The secondary outcome measures were the electrophysiological tests. The examinations were performed at baseline, and then at 4th and 8th weeks.
                At the end of the study, a statistically significant improvement was obtained in all clinical parameters in the group B: VAS pain, severity of symptoms, functional status, grip strength (p < 0.001 for each) and two-point discrimination (p < 0.016). Also the group A showed significant improvements in all clinical parameters (p < 0.001 for each), except for the grip strength. Additionally, significant improvements in the median nerve sensory conduction velocity and distal motor latency were also found in both groups at the end of the 8 week follow-up period. There was no significant difference between the groups in the primary and secondary outcome measures, except for the grip strength.
                Both ultrasound treatment and corticosteroid injection plus splinting were effective on the clinical symptoms and the electrophysiological findings of CTS. Thus, the ultrasound therapy may be an alternative treatment for CTS, particularly in patient who do not accept injection or splinting (Tab. 3, Fig. 2, Ref. 36). We investigated the efficacy of a single vs. double steroid injections in the treatment of carpal tunnel syndrome (CTS) in a randomised double-blind controlled trial. Patients with idiopathic CTS were randomised into (i) one group receiving a baseline methylprednisolone acetate injection plus a saline injection 8 weeks later and (ii) a second group receiving methylprednisolone acetate injection at baseline and at 8 weeks. The primary outcome was the Global Symptom Score (GSS). Forty patients were recruited. By 40 weeks, the mean GSS improved from 25.6 to 14.1 in the single-injection group whereas from 26.7 to 12.6 in the reinjection group, but there was no significant difference in GSS between the two groups (p = 0.26). There were also no significant differences in terms of electrophysiological and functional outcomes. The results suggest that an additional steroid injection confers no added benefit to a single injection in terms of symptom relief. To compare low and high dose, and short and long acting corticosteroids in the treatment of carpal tunnel syndrome.
                A randomised, controlled, single blind trial with electromyographic and subjective outcome measures.
                25 mg hydrocortisone is as effective as higher doses or long acting triamcinolone at a six week and six month follow up.
                As low dose steroid is as effective, and potentially less toxic, this should be the recommended dose for injection of carpal tunnel syndrome. To compare the efficacy of local corticosteroid injection to a nonsteroidal antiinflammatory drug and splinting for the treatment of carpal tunnel syndrome.
                This study was a prospective, unblinded, randomized clinical trial with an 8-wk follow-up. Thirty-three hands of 23 patients were randomly treated with acemetacine and splinting (group A) or with corticosteroid injection (group B). Clinical (symptom severity scale, visual analog scale, Tinel and Phalen tests) and electromyographic evaluations were performed on initial visit and after 8 wk.
                Clinical and electromyographic parameters, which were similar at baseline, were improved in both groups after treatment. Improvement was also similar when both groups were compared at 8 wk.
                Both splinting combined with the use of a nonsteroidal antiinflammatory drug and steroid injection into the carpal tunnel resulted in significant improvement in carpal tunnel syndrome. Optimal treatment of carpal tunnel syndrome (CTS) has not been established. This study compared the effects of local steroid injection versus surgical decompression in new-onset CTS of at least 3 months' duration.
                In a 1-year, prospective, randomized, open, controlled clinical trial, we studied the effects of surgical decompression versus local steroid injection in 163 wrists with a clinical and neurophysiologic diagnosis of CTS. Clinical assessments were done at baseline and at 3, 6, and 12 months after treatment. The primary end point was the percentage of wrists that reached a >or=20% improvement in the visual analog scale score for nocturnal paresthesias at 3 months of followup. Statistical analysis was done by Student's t-test for continuous variables and by chi-square test for categorical variables. Analyses were performed on an intent-to-treat basis. P values less than 0.05 were considered statistically significant.
                Both treatment groups had comparable severity of CTS at baseline. Eighty wrists were randomly assigned to the surgery group and 83 wrists to the local steroid injection group. In the intent-to-treat analysis, at 3 months of followup, 94.0% of the wrists in the steroid injection group versus 75.0% in the surgery group reached a 20% response for nocturnal paresthesias (P = 0.001). At 6 and 12 months, the percentages of responders were 85.5% versus 76.3% (P = 0.163) and 69.9% versus 75.0% (P = 0.488), for local steroid injection and surgical decompression, respectively.
                Over the short term, local steroid injection is better than surgical decompression for the symptomatic relief of CTS. At 1 year, local steroid injection is as effective as surgical decompression for the symptomatic relief of CTS. In order to investigate the superiority of local steroid injection over the intramuscular route, 37 patients with idiopathic carpal tunnel syndrome were treated with local or systemic steroid injections in a double-blind study. The first group received steroid injections into the carpal tunnel of the more severely affected hand and placebo into the deltoid muscle of the same side. The second group received steroid injections intramuscularly, and placebo into the carpal tunnel. The only significant improvement observed at the end of one month was in the steroid-injected hands of the first group. At 10-12 months follow-up only four (22%) of the 18 patients from this Group were symptom free. Conservative treatment of mild to moderate carpal tunnel syndrome (CTS) is variable.
                To evaluate the effectiveness of commonly used oral medications such as diuretics, nonsteroid anti-inflammatory drugs (NSAIDs), and steroids in the treatment of CTS.
                Prospective, randomized, double-blind and placebo-controlled study of patients with clinical symptoms and signs of CTS, confirmed by standard electrodiagnosis. Baseline assessments included a standardized symptom questionnaire, rating five categories of symptoms (pain, numbness, paresthesia, weakness/clumsiness, and nocturnal awakening) on a scale from 0 (no symptoms) to 10 (severe). The total score in each of the five categories was termed the global symptom score (GSS). After baseline assessment, patients were randomized to the following treatment arms: 1) 4 weeks of placebo (n = 16); 2) 4 weeks of diuretic (trichlormethiazide, 2 mg daily; n = 16); 3) 4 weeks of NSAID-slow release (SR) (tenoxicam-SR, 20 mg daily; n = 18); and 4) 2 weeks of prednisolone, 20 mg daily, followed by another 2-week dosage of 10 mg daily (n = 23). Results of follow-up assessments in the second and the fourth weeks were identical to baseline scores. The changes in GSS were analyzed to determine the statistical difference.
                No significant reduction from baseline GSS was seen at second, and fourth weeks in the placebo, NSAID-SR, and diuretic groups. However, the mean score at 4 weeks in the steroid group decreased significantly from a baseline of 27.9 +/- 6.9 to 10 +/- 7.4.
                For patients with mild to moderate CTS who opt for conservative treatment, corticosteroids are of greater benefit.
Local corticosteroid injection for carpal tunnel syndrome provides greater clinical improvement in symptoms one month after injection compared to placebo. Significant symptom relief beyond one month has not been demonstrated. Local corticosteroid injection provides significantly greater clinical improvement than oral corticosteroid for up to three months. Local corticosteroid injection does not significantly improve clinical outcome compared to either anti-inflammatory treatment and splinting after eight weeks or Helium-Neon laser treatment after six months. Two local corticosteroid injections do not provide significant added clinical benefit compared to one injection.