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Steroid Injections for the Carpal Tunnel Syndrome FREE

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The full report is titled “Methylprednisolone Injections for the Carpal Tunnel Syndrome. A Randomized, Placebo-Controlled Trial.” It is in the 3 September 2013 issue of Annals of Internal Medicine (volume 159, pages 309-317). The authors are I. Atroshi, M. Flondell, M. Hofer, and J. Ranstam.

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Ann Intern Med. 2013;159(5):I-18. doi:10.7326/0003-4819-159-5-201309030-00001
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What is the problem and what is known about it so far?

Carpal tunnel syndrome is a common condition in adults that can result in pain, tingling, and weakness in the affected hand. Both hands are often involved. The most common initial treatment is wrist splinting. When splinting is ineffective, steroid injections are often given and provide relief. However, it is difficult to know whether steroids are really the reason for improvement because the condition sometimes gets better on its own. When symptoms persist, surgery is performed. Although such surgery usually resolves the condition, it is associated with short-term pain and limitation of use of the operated hand as well as increased medical costs.

Why did the researchers do this particular study?

To see how often patients who received steroids decided to have surgery compared with those who received placebo.

Who was studied?

111 patients aged 18 to 70 years with the carpal tunnel syndrome who had no previous steroid injections.

How was the study done?

The researchers treated patients in a way that neither they nor the patients knew whether methylprednisolone (a form of steroid) or placebo was being injected. The researchers followed patients for 1 year after injection to assess whether injecting steroids helped some patients feel better and avoid surgery.

What did the researchers find?

Patients who received methylprednisolone injections were less likely to report pain, numbness, tingling, and other symptoms when evaluated 10 weeks later compared with patients who received placebo. One year after injection, somewhat fewer patients who received steroids had surgery compared with those who received placebo. However, the benefit was not large because 3 out of 4 patients who received steroids still had surgery within 1 year.

What were the limitations of the study?

Only patients who had not improved with wrist splinting were enrolled in the study. Patients with severe weakness and loss of sensation and pregnant women were not included.

What are the implications of the study?

In patients with the carpal tunnel syndrome who have been treated unsuccessfully with wrist splinting, a steroid injection into the carpal tunnel space often provides relief in the short term and enables some patients to avoid surgery. However, most patients who respond to steroid treatment will still decide to have surgery within 1 year because of persistent symptoms and limitations in hand function.





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