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Randomised controlled trial of local corticosteroid injections for carpal tunnel syndrome in general practice.

Peters-Veluthamaningal C, Winters JC, Groenier KH, Meyboom-de Jong B - BMC Fam Pract (2010)

Bottom Line: Carpal tunnel syndrome is caused by entrapment of the median nerve and results in pain, tingling and numbness in the wrist and hand.Corticosteroid injections for CTS provided by general practitioners are effective regarding short-term outcomes when compared to placebo injections.The short-term beneficial treatment effects of steroid injections deteriorated during the follow-up period of twelve months and half of the cohort of steroid-responders had recurrences.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Practice, University Medical Center Groningen, Groningen, the Netherlands.

ABSTRACT

Background: Carpal tunnel syndrome is caused by entrapment of the median nerve and results in pain, tingling and numbness in the wrist and hand. It is a common condition in general practice. Effectiveness of treatment by intracarpal corticosteroid injection has never been investigated in general practice. The objective of this study was to determine if corticosteroid injections for carpal tunnel syndrome provided by general practitioners are effective.

Methods: In this study 69 participants with a clinical diagnosis of carpal tunnel syndrome were recruited from 20 general practices. Short-term outcomes were assessed in a randomised, placebo-controlled trial. Long-term results were assessed in a prospective cohort-study of steroid responders. Participants were randomised to intracarpal injections of 1 ml triamcinolonacetonide 10 mg/ml (TCA) or 1 ml NaCl (placebo). Non-responders to NaCl were treated with additional TCA injections. Main outcomes were immediate treatment success, mean score of the Symptom Severity Scale (SSS) and Functional Status Scale (FSS) of the Boston carpal tunnel questionnaire, subjective improvement and proportion of participants with recurrences during follow-up. Duration of follow-up was twelve months.

Results: The TCA-group (36 participants) had better outcomes than the NaCl-group (33 participants) during short-term assessment for outcome measures treatment response, mean improvement of SSS-score (the mean difference in change score was 0.637 {95% CI: 0.320, 0.960; p < 0.001}) and FSS-score (the mean difference in change score was 0.588 {95% CI: 0.232, 0.944; p = 0.002}) and perceived improvement (p = 0.01). The number to treat to achieve satisfactory partial treatment response or complete resolution of symptoms and signs was 3 (95% CI:1.83, 9.72).49% of TCA-responders (17/35) had recurrences during follow-up. In the group of TCA-responders without recurrences (51%, 18/35) outcomes for SSS-score and FSS-score deteriorated during the follow-up period of 12 months (resp. p = 0.008 and p = 0.012).

Conclusions: Corticosteroid injections for CTS provided by general practitioners are effective regarding short-term outcomes when compared to placebo injections. The short-term beneficial treatment effects of steroid injections deteriorated during the follow-up period of twelve months and half of the cohort of steroid-responders had recurrences.

Trial registration: Current Controlled Trials ISRCTN53171398.

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BCTQ functional score of responders to TCA during follow-up
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Figure 3: BCTQ functional score of responders to TCA during follow-up

Mentions: In the cohort that remained free of recurrences the short term beneficial treatment effects of steroid injection(s) deteriorated during follow-up: main outcomes BCTQ SSS (1.45, 1.55, 2.05 and 2.03 at resp. 1, 3, 6 and 12 months follow-up; p = 0.008) and BCTQ FSS (1.08, 1.19, 1.28 and 1.66 at resp. 1, 3, 6 and 12 months follow-up; p = 0.012) increased during the entire follow-up period of twelve months (figure 2 and 3, table 3), however they did not reach the pre-intervention levels (the median score for the BCTQ SSS was 2.90 and for the BCTQ FSS 2.50 at baseline for the participants treated with TCA-injections).


Randomised controlled trial of local corticosteroid injections for carpal tunnel syndrome in general practice.

Peters-Veluthamaningal C, Winters JC, Groenier KH, Meyboom-de Jong B - BMC Fam Pract (2010)

BCTQ functional score of responders to TCA during follow-up
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2921105&req=5

Figure 3: BCTQ functional score of responders to TCA during follow-up
Mentions: In the cohort that remained free of recurrences the short term beneficial treatment effects of steroid injection(s) deteriorated during follow-up: main outcomes BCTQ SSS (1.45, 1.55, 2.05 and 2.03 at resp. 1, 3, 6 and 12 months follow-up; p = 0.008) and BCTQ FSS (1.08, 1.19, 1.28 and 1.66 at resp. 1, 3, 6 and 12 months follow-up; p = 0.012) increased during the entire follow-up period of twelve months (figure 2 and 3, table 3), however they did not reach the pre-intervention levels (the median score for the BCTQ SSS was 2.90 and for the BCTQ FSS 2.50 at baseline for the participants treated with TCA-injections).

Bottom Line: Carpal tunnel syndrome is caused by entrapment of the median nerve and results in pain, tingling and numbness in the wrist and hand.Corticosteroid injections for CTS provided by general practitioners are effective regarding short-term outcomes when compared to placebo injections.The short-term beneficial treatment effects of steroid injections deteriorated during the follow-up period of twelve months and half of the cohort of steroid-responders had recurrences.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Practice, University Medical Center Groningen, Groningen, the Netherlands.

ABSTRACT

Background: Carpal tunnel syndrome is caused by entrapment of the median nerve and results in pain, tingling and numbness in the wrist and hand. It is a common condition in general practice. Effectiveness of treatment by intracarpal corticosteroid injection has never been investigated in general practice. The objective of this study was to determine if corticosteroid injections for carpal tunnel syndrome provided by general practitioners are effective.

Methods: In this study 69 participants with a clinical diagnosis of carpal tunnel syndrome were recruited from 20 general practices. Short-term outcomes were assessed in a randomised, placebo-controlled trial. Long-term results were assessed in a prospective cohort-study of steroid responders. Participants were randomised to intracarpal injections of 1 ml triamcinolonacetonide 10 mg/ml (TCA) or 1 ml NaCl (placebo). Non-responders to NaCl were treated with additional TCA injections. Main outcomes were immediate treatment success, mean score of the Symptom Severity Scale (SSS) and Functional Status Scale (FSS) of the Boston carpal tunnel questionnaire, subjective improvement and proportion of participants with recurrences during follow-up. Duration of follow-up was twelve months.

Results: The TCA-group (36 participants) had better outcomes than the NaCl-group (33 participants) during short-term assessment for outcome measures treatment response, mean improvement of SSS-score (the mean difference in change score was 0.637 {95% CI: 0.320, 0.960; p < 0.001}) and FSS-score (the mean difference in change score was 0.588 {95% CI: 0.232, 0.944; p = 0.002}) and perceived improvement (p = 0.01). The number to treat to achieve satisfactory partial treatment response or complete resolution of symptoms and signs was 3 (95% CI:1.83, 9.72).49% of TCA-responders (17/35) had recurrences during follow-up. In the group of TCA-responders without recurrences (51%, 18/35) outcomes for SSS-score and FSS-score deteriorated during the follow-up period of 12 months (resp. p = 0.008 and p = 0.012).

Conclusions: Corticosteroid injections for CTS provided by general practitioners are effective regarding short-term outcomes when compared to placebo injections. The short-term beneficial treatment effects of steroid injections deteriorated during the follow-up period of twelve months and half of the cohort of steroid-responders had recurrences.

Trial registration: Current Controlled Trials ISRCTN53171398.

Show MeSH
Related in: MedlinePlus