Long-term effectiveness of steroid injections and splinting in mild and moderate carpal tunnel syndrome. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. Corticosteroid injection vs. nonsteroidal antiinflammatory drug and splinting in carpal tunnel syndrome. Injection with methylprednisolone proximal to the carpal tunnel: randomised double blind trial. Splinting for carpal tunnel syndrome: in search of the optimal angle. Postoperative splinting after open carpal tunnel release does not improve functional and neurological outcome. Efficacy of acupuncture versus night splinting for carpal tunnel syndrome: a randomized clinical trial. The efficacy of local steroid injections in idiopathic carpal tunnel syndrome: a double-blind study. Yoga-based intervention for carpal tunnel syndrome: a randomized trial. The comparison of ultrasound treatment and local steroid injection plus splinting in the carpal tunnel syndrome: a randomized controlled trial. Intracarpal steroid injection is safe and effective for short-term management of carpal tunnel syndrome.
To evaluate the long-term efficacy of non-surgical treatment methods for mild and moderate carpal tunnel syndrome, 120 patients with clinical symptoms and electrophysiologic evidence were included in a prospective, randomized and blinded trial: 60 patients were instructed to wear splints every night, 30 received injections of betamethasone 4 cm proximal to the carpal tunnel, and 30 received injections distal to the carpal tunnel. After approximately 1 year (mean, 11 months; range, 9-14), 108 patients were available for final evaluation. We assessed clinical symptom severity and performed detailed electrophysiologic examinations before and after treatment. Splinting provided symptomatic relief and improved sensory and motor nerve conduction velocities at the long-term follow-up when the splints were worn almost every night. Proximal and distal injections of steroids were ineffective on the basis of both clinical symptoms and electrophysiologic findings. Decompressive surgery and steroid injection are widely used forms of treatment for carpal tunnel syndrome (CTS) but there is no consensus on their effectiveness in comparison to each other. The authors evaluated the efficacy of surgery vs steroid injection in relieving symptoms in patients with CTS.
                The authors conducted a randomized, single blind, controlled trial. Fifty patients with electrophysiologically confirmed idiopathic CTS were randomized and assigned to open carpal tunnel release (25 patients) or to a single injection of steroid (25 patients). Patients were followed up at 6 and 20 weeks. The primary outcome was symptom relief in terms of the Global Symptom Score (GSS), which rates symptoms on a scale of 0 (no symptoms) to 50 (most severe). Nerve conduction studies and grip strength measurements were used as secondary outcome assessments.
                At 20 weeks after randomization, patients who underwent surgery had greater symptomatic improvement than those who were injected. The mean improvement in GSS after 20 weeks was 24.2 (SD 11.0) in the surgery group vs 8.7 (SD 13.0) in the injection group (p < 0.001); surgical decompression also resulted in greater improvement in median nerve distal motor latencies and sensory nerve conduction velocity. Mean grip strength in the surgical group was reduced by 1.7 kg (SD 5.1) compared with a gain of 2.4 kg (SD 5.5) in the injection group.
                Compared with steroid injection, open carpal tunnel release resulted in better symptomatic and neurophysiologic outcome but not grip strength in patients with idiopathic carpal tunnel syndrome over a 20-week period. To compare the efficacy of local corticosteroid injection to a nonsteroidal antiinflammatory drug and splinting for the treatment of carpal tunnel syndrome.
                This study was a prospective, unblinded, randomized clinical trial with an 8-wk follow-up. Thirty-three hands of 23 patients were randomly treated with acemetacine and splinting (group A) or with corticosteroid injection (group B). Clinical (symptom severity scale, visual analog scale, Tinel and Phalen tests) and electromyographic evaluations were performed on initial visit and after 8 wk.
                Clinical and electromyographic parameters, which were similar at baseline, were improved in both groups after treatment. Improvement was also similar when both groups were compared at 8 wk.
                Both splinting combined with the use of a nonsteroidal antiinflammatory drug and steroid injection into the carpal tunnel resulted in significant improvement in carpal tunnel syndrome. To assess the effect of a 40 mg methylprednisolone injection proximal to the carpal tunnel in patients with the carpal tunnel syndrome.
                Randomised double blind placebo controlled trial.
                Outpatient neurology clinic in a district general hospital.
                Patients with symptoms of the carpal tunnel syndrome for more than 3 months, confirmed by electrophysiological tests and aged over 18 years.
                Injection with 10 mg lignocaine (lidocaine) or 10 mg lignocaine and 40 mg methylprednisolone. Non-responders who had received lignocaine received 40 mg methylprednisolone and 10 mg lignocaine and were followed in an open study.
                Participants were scored as having improved or not improved. Improved was defined as no symptoms or minor symptoms requiring no further treatment.
                At 1 month 6 (20%) of 30 patients in the control group had improved compared with 23 (77%) of 30 patients the intervention group (difference 57% (95% confidence interval 36% to 77%)). After 1 year, 2 of 6 improved patients in the control group did not need a second treatment, compared with 15 of 23 improved patients in the intervention group (difference 43% (23% to 63%). Of the 28 non-responders in the control group, 24 (86%) improved after methylprednisolone. Of these 24 patients, 12 needed surgical treatment within one year.
                A single injection with steroids close to the carpal tunnel may result in long term improvement and should be considered before surgical decompression. Carpal tunnel syndrome (CTS) is the most common of the compression neuropathies. Several studies have demonstrated the efficacy of wrist splinting in relieving the symptoms of CTS; however, the chosen angle of immobilization has varied. Wick catheter measurements of carpal tunnel pressures suggest that the neural position has less pressure and, therefore, greater potential to provide relief from symptoms. This study is a prospectively gathered, blind trial comparing the symptom relief experienced by wearers of splints immobilized at 20 degrees extension and at neutral. The results indicate that the neutral angle provided superior symptom relief, and that the relief did not often improve between 2 weeks and 2 months of wear. Relief of symptoms was not related to the length of time that the patient had experienced of CTS symptoms. The results also indicate that the results of the electromyography/nerve conduction study (EMG/NCS) do not provide information about the subjects' likely response to splinting. Although surgical division of the transverse carpal ligament is the operative treatment of choice for carpal tunnel syndrome (CTS), controversy exists about the immediate postoperative treatment regimen. Splinting for up to 6 weeks after surgery is recommended by some investigators. We therefore evaluated effectiveness of splinting after open carpal tunnel surgery by a randomized, controlled trial. Fifty consecutive patients with clinically and electrophysiologically confirmed idiopathic CTS were assigned to open carpal tunnel release and randomized to receiving a light bandage (25 patients) or a bulky dressing with a volar splint (25 patients) for 2 days each. All patients were followed up at 3 months. Parameters retrieved were pain as measured using a visual analog scale, two-point discrimination, and grip strength, and nerve conduction studies. At follow-up, all patients reported definite improvement of symptoms, but there was no statistically significant difference between the two groups for any of our outcome measures. Thus, postoperative splinting after open carpal tunnel release does not yield any benefit to eventual outcome. In fact, it adds to the overall operating time and can safely be abandoned. To compare the efficacy of acupuncture with night splinting for carpal tunnel syndrome (CTS).
                Sixty one mild-to-moderate degree CTS patients, aged 27-67 were randomly assigned to acupuncture (Acu) and night splinting (NS) groups. The Acu group received 10 sessions of electro-acupuncture twice a week. The NS group received prefabricated volar neutral wrist splint during the night for 5 weeks. Outcomes were assessed at baseline and the end of treatment protocol by Boston Carpal Tunnel Scale comprising symptom severity scale (SSS) and functional status scale (FSS). Pain was measured by 100 mm visual analog scale (VAS).
                VAS decreased more in Acu than in the NS group (p = 0.028) whereas improvements in SSS and FSS were not significant between both groups.
                Electro-acupuncture was as effective as night splinting in respect of overall symptoms and functions in mild-to-moderate degree CTS. However, pain was reduced more by electro-acupuncture than night splinting. In order to investigate the superiority of local steroid injection over the intramuscular route, 37 patients with idiopathic carpal tunnel syndrome were treated with local or systemic steroid injections in a double-blind study. The first group received steroid injections into the carpal tunnel of the more severely affected hand and placebo into the deltoid muscle of the same side. The second group received steroid injections intramuscularly, and placebo into the carpal tunnel. The only significant improvement observed at the end of one month was in the steroid-injected hands of the first group. At 10-12 months follow-up only four (22%) of the 18 patients from this Group were symptom free. Carpal tunnel syndrome is a common complication of repetitive activities and causes significant morbidity.
                To determine the effectiveness of a yoga-based regimen for relieving symptoms of carpal tunnel syndrome.
                Randomized, single-blind, controlled trial.
                A geriatric center and an industrial site in 1994-1995.
                Forty-two employed or retired individuals with carpal tunnel syndrome (median age, 52 years; range, 24-77 years).
                Subjects assigned to the yoga group received a yoga-based intervention consisting of 11 yoga postures designed for strengthening, stretching, and balancing each joint in the upper body along with relaxation given twice weekly for 8 weeks. Patients in the control group were offered a wrist splint to supplement their current treatment.
                Changes from baseline to 8 weeks in grip strength, pain intensity, sleep disturbance, Phalen sign, and Tinel sign, and in median nerve motor and sensory conduction time.
                Subjects in the yoga groups had significant improvement in grip strength (increased from 162 to 187 mm Hg; P = .009) and pain reduction (decreased from 5.0 to 2.9 mm; P = .02), but changes in grip strength and pain were not significant for control subjects. The yoga group had significantly more improvement in Phalen sign (12 improved vs 2 in control group; P = .008), but no significant differences were found in sleep disturbance, Tinel sign, and median nerve motor and sensory conduction time.
                In this preliminary study, a yoga-based regimen was more effective than wrist splinting or no treatment in relieving some symptoms and signs of carpal tunnel syndrome. This study aimed to compare the efficacy of ultrasound treatment to local corticosteroid injection plus splinting in carpal tunnel syndrome (CTS). There is still limited knowledge on the efficacy of conservative treatment options for CTS.
                Fourty-nine hands of 34 patients with CTS were enrolled in this study. Patients were randomly assigned to the ultrasound treatment (group A) or local corticosteroid injection plus splinting (group B). The primary outcome measures included clinical parameters such as symptoms severity score, visual analogue scale (VAS) pain, functional status score, grip strength and two-point discrimination. The secondary outcome measures were the electrophysiological tests. The examinations were performed at baseline, and then at 4th and 8th weeks.
                At the end of the study, a statistically significant improvement was obtained in all clinical parameters in the group B: VAS pain, severity of symptoms, functional status, grip strength (p < 0.001 for each) and two-point discrimination (p < 0.016). Also the group A showed significant improvements in all clinical parameters (p < 0.001 for each), except for the grip strength. Additionally, significant improvements in the median nerve sensory conduction velocity and distal motor latency were also found in both groups at the end of the 8 week follow-up period. There was no significant difference between the groups in the primary and secondary outcome measures, except for the grip strength.
                Both ultrasound treatment and corticosteroid injection plus splinting were effective on the clinical symptoms and the electrophysiological findings of CTS. Thus, the ultrasound therapy may be an alternative treatment for CTS, particularly in patient who do not accept injection or splinting (Tab. 3, Fig. 2, Ref. 36). A double-blinded placebo-controlled trial was performed to evaluate the use of steroid injections beneath the transverse carpal ligament in the treatment of carpal tunnel syndrome (CTS) refractory to nonsurgical therapy. Forty-three patients received 6 mg betamethasone and lidocaine and 38 patients received 1 ml saline placebo and lidocaine. The primary outcome measure was satisfaction with symptom relief. Thirty patients (70%) in the steroid-treated group were satisfied or highly satisfied compared with 13 (34%) of placebo-treated patients (P < 0.001). Patients receiving steroids also showed significant improvement in median nerve conduction parameters and scores on validated symptom/function questionnaires. Forty-six patients were treated with serial injections for recurrent CTS symptoms. After 18 months, 17 patients reported adequate symptom relief with steroid injection, and 18 patients with unsatisfactory symptom relief were referred for carpal tunnel release surgery. We conclude that although steroid injections are safe and effective for temporary relief of CTS, most patients will eventually require surgery for long-term control of their symptoms.
Surgical treatment of carpal tunnel syndrome relieves symptoms significantly better than splinting. Further research is needed to discover whether this conclusion applies to people with mild symptoms and whether surgical treatment is better than steroid injection.