Isam Atroshi, MD, PhD; Magnus Flondell, MD; Manfred Hofer, BSc; Jonas Ranstam, PhD
Acknowledgment: The authors thank Pia Gunnarsson, study nurse, and Ingela Ranebo, research nurse, at the Department of Orthopedics at Hässleholm and Kristianstad Hospitals for assistance in conducting the trial. They also thank Håkan Lövkvist, PhD, and Professor Jonas Björk at the Medical Statistics and Epidemiology Unit, Skåne Research and Development Center, for their statistical contributions.
Grant Support: By the Region of Scania Research and Development Foundation and Hässleholm Hospital Organization.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-3068.
Reproducible Research Statement: Study protocol: Available from Dr. Atroshi (e-mail, Isam.Atroshi@skane.se). Statistical code: Available from Professor Ranstam (e-mail, email@example.com). Data set: Request for data can be submitted to Dr. Atroshi (e-mail, Isam.Atroshi@skane.se).
Corresponding Author: Isam Atroshi, MD, PhD, Department of Orthopedics, Hässleholm Hospital, SE 28125 Hässleholm, Sweden; e-mail, Isam.Atroshi@skane.se.
Current Author Addresses: Dr. Atroshi: Department of Orthopedics, Hässleholm Hospital, SE 28125, Hässleholm, Sweden.
Dr. Flondell: Department of Hand Surgery, Skåne University Hospital, SE 20502, Malmö, Sweden.
Mr. Hofer: Department of Physical Therapy, Kristianstad Hospital, SE 29185 Kristianstad, Sweden.
Professor Ranstam: Department of Orthopedics, Lund University, SE 22185, Lund, Sweden.
Author Contributions: Conception and design: I. Atroshi, M. Flondell, M. Hofer.
Analysis and interpretation of the data: I. Atroshi, J. Ranstam.
Drafting of the article: I. Atroshi, M. Flondell.
Critical revision of the article for important intellectual content: I. Atroshi, M. Hofer, J. Ranstam.
Final approval of the article: I. Atroshi, M. Flondell, M. Hofer, J. Ranstam.
Provision of study materials or patients: M. Flondell.
Statistical expertise: J. Ranstam.
Obtaining of funding: I. Atroshi, M. Flondell.
Administrative, technical, or logistic support: I. Atroshi, M. Flondell, M. Hofer.
Collection and assembly of data: I. Atroshi, M. Flondell, M. Hofer.
Atroshi I, Flondell M, Hofer M, Ranstam J. Methylprednisolone Injections for the Carpal Tunnel Syndrome: A Randomized, Placebo-Controlled Trial. Ann Intern Med. 2013;159:309-317. doi: 10.7326/0003-4819-159-5-201309030-00004
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Published: Ann Intern Med. 2013;159(5):309-317.
Steroid injections are used in idiopathic carpal tunnel syndrome (CTS), but evidence of efficacy beyond 1 month is lacking.
To assess the efficacy of local methylprednisolone injections in CTS.
Randomized, placebo-controlled trial. (ClinicalTrials.gov: NCT00806871)
Regional referral orthopedic department in Sweden.
Patients aged 18 to 70 years with CTS but no previous steroid injections.
Three groups (37 patients each) received 80 mg of methylprednisolone, 40 mg of methylprednisolone, or placebo. The patients and treating surgeons were blinded.
Primary end points were the change in CTS symptom severity scores at 10 weeks (range, 1 to 5) and rate of surgery at 1 year. Three patients had missing 10-week data. All patients had 1-year data.
Improvement in CTS symptom severity scores at 10 weeks was greater in patients who received 80 mg of methylprednisolone and 40 mg of methylprednisolone than in those who received placebo (difference in change from baseline, −0.64 [95% CI, −1.06 to −0.21; P = 0.003] and −0.88 [CI, −1.30 to −0.46; P < 0.001], respectively), but there were no significant differences at 1 year. The 1-year rates of surgery were 73%, 81%, and 92% in the 80-mg methylprednisolone, 40-mg methylprednisolone, and placebo groups, respectively. Compared with patients who received placebo, those who received 80 mg of methylprednisolone were less likely to have surgery (odds ratio, 0.24 [CI, 0.06 to 0.95]; P = 0.042). With time to surgery incorporated, both the 80- and 40-mg methylprednisolone groups had lower likelihood of surgery (hazard ratio, 0.46 [CI, 0.27 to 0.77; P = 0.003] and 0.57 [CI, 0.35 to 0.94; P = 0.026], respectively).
The study was conducted at 1 center, and wrist splinting had previously failed for all patients.
Methylprednisolone injections for CTS have significant benefits in relieving symptoms at 10 weeks and reducing the rate of surgery 1 year after treatment, but 3 out of 4 patients had surgery within 1 year.
Region of Scania Research and Development Foundation and Hässleholm Hospital Organization.
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