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

BMC Family Practice

Research Article

Cyriac Peters-Veluthamaningal¹  Klaas H Groenier¹  Betty Meyboom-de Jong¹  Jan C Winters¹ 

[1] Department of General Practice, University Medical Center Groningen, Groningen, The Netherlands;

关键词: Carpal Tunnel Syndrome;    Carpal Tunnel;    Secondary Care;    Steroid Injection;    Nerve Conduction Study;   

DOI  :  10.1186/1471-2296-11-54

 received in 2009-07-07, accepted in 2010-07-29,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundCarpal 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.MethodsIn 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.ResultsThe 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).ConclusionsCorticosteroid 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 registrationCurrent Controlled Trials ISRCTN53171398

【 授权许可】

CC BY   
© Peters-Veluthamaningal et al; licensee BioMed Central Ltd. 2010