Single Steroid injection superior to night splints in carpal tunnel syndrome

A new study published in the journal The Lancet reports that a single corticosteroid injection shows superior clinical effectiveness at 6 weeks compared with night-resting splints for rapid symptom response in mild or moderate carpal tunnel syndrome.

Carpal tunnel syndrome is the most common compression neuropathy affecting the upper limb, which results from entrapment of the median nerve in the carpal tunnel. It adversely affects daily activities, limits work capacity and impacts on general health and quality of life

According to the authors, the comparative effectiveness of commonly used conservative treatments for carpal tunnel syndrome has not been evaluated previously in primary care. Moving a step ahead. Linda Chesterton and associates conducted a randomized, open-label, pragmatic trial to compare the clinical and cost-effectiveness of night splints with a corticosteroid injection with regards to reducing symptoms and improving hand function in patients with mild or moderate carpal tunnel syndrome.

The study enrolled adults (≥18 years) with a new episode of idiopathic mild or moderate carpal tunnel syndrome of at least 6 weeks' duration from 25 primary and community musculoskeletal clinics and services.

Read Also: Management of carpal tunnel syndrome : American Academy of Orthopaedic Surgeons guidelines
The study participants were randomly assigned (1:1) to receive either a single injection of 20 mg methylprednisolone acetate (from 40 mg/mL) or a night-resting splint to be worn for 6 weeks.The primary outcome was the overall score of the Boston Carpal Tunnel Questionnaire (BCTQ) at 6 weeks.

A total of 234 participants were randomly assigned (118 to the night splint group and 116 to the corticosteroid injection group), of whom 212 (91%) completed the BCTQ at 6 weeks.

The study found that the BCTQ score was significantly better at 6 weeks in the corticosteroid injection group (mean 2·02) than the night splint group (2·29). No adverse events were reported.

“To our knowledge, this trial is the largest randomized comparison of the short-term and medium-term effectiveness of corticosteroid injection versus night splint for the treatment of carpal tunnel syndrome and the first to be done in a primary care setting; where most patients presenting with mild or moderate symptoms are managed,” write the authors.

The study concluded that a single corticosteroid injection shows superior clinical effectiveness at 6 weeks and is cost-effective over 6 months compared with night resting splints, which should make it the treatment of choice for rapid and sustained symptom response in mild or moderate carpal tunnel syndrome presenting in primary care.

For further reference log on to https://doi.org/10.1016/S0140-6736(18)31572-1