Methylprednisolone Injections for the Carpal Tunnel Syndrome

Atroshi, Isam; Flondell, Magnus; Hofer, Manfred; Ranstam, Jonas

doi:10.7326/0003-4819-159-5-201309030-00004

Cited by 101 publications

(117 citation statements)

References 25 publications

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“…23 A recent randomised controlled trial compared three groups (37 patients each) receiving 80 mg methylprednisolone steroid injection, 40 mg methylprednisolone steroid injection, and placebo and found that steroid injections improved symptom scores at 10 weeks but that there was no difference with placebo at one year. 24 Overall, 75% of the patients had surgery within one year. The results of carpal tunnel injection are reported to be worse for patients with more clinically severe disease, those with diabetes, older people, and where symptoms are permanent or unremitting.…”

Section: Corticosteroid Injectionmentioning

confidence: 99%

Carpal tunnel syndrome

Middleton

Anakwe

2014

BMJ

127

129

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Section: Corticosteroid Injectionmentioning

confidence: 99%

Carpal tunnel syndrome

Middleton

Anakwe

2014

BMJ

127

129

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“…11 A recent randomized controlled trial (RCT) also showed that steroid injection provided more benefits than placebo at the 10th week of treatment, but there was no significant difference observed at 1-year follow-up. 12 Only one-third of patients with carpal tunnel syndrome who received steroid injections had longer term benefits 13 and some required an additional 2-3 injections to obtain relief. 13 However, 1 study conducted in Estonia reported that patients who received repetitive steroid injections were more likely to have postoperative symptoms of carpal tunnel syndrome if they eventually opted for surgery.…”

mentioning

confidence: 99%

Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial

Chung

Liu

et al. 2016

CMAJ

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Background:The effectiveness of acupuncture for managing carpal tunnel syndrome is uncertain, particularly in patients already receiving conventional treatments (e.g., splinting). We aimed to assess the effects of electroacupuncture combined with splinting. Methods:We conducted a randomized parallel-group assessor-blinded 2-arm trial on patients with clinically diagnosed primary carpal tunnel syndrome. The treatment group was offered 13 sessions of electroacupuncture over 17 weeks. The treatment and control groups both received continuous nocturnal wrist splinting. Results:Of 181 participants randomly assigned to electroacupuncture combined with splinting (n = 90) or splinting alone (n = 91), 174 (96.1%) completed all follow-up. The electroacupuncture group showed greater improvements at 17 weeks in symptoms (primary outcome of Symptom Severity Scale score mean difference [MD] -0.20, 95% confidence interval [CI] -0.36 to -0.03), disability (Disability of Arm, Shoulder and Hand Questionnaire score MD -6.72, 95% CI -10.9 to -2.57), function (Functional Status Scale score MD -0.22, 95% CI -0.38 to -0.05), dexterity (time to complete blinded pick-up test MD -6.13 seconds, 95% CI -10.6 to -1.63) and maximal tip pinch strength (MD 1.17 lb, 95% CI 0.48 to 1.86). Differences between groups were small and clinically unimportant for reduction in pain (numerical rating scale -0.70, 95% CI -1.34 to -0.06), and not significant for sensation (first finger monofilament test -0.08 mm, 95% CI -0.22 to 0.06).Interpretation: For patients with primary carpal tunnel syndrome, chronic mild to moderate symptoms and no indication for surgery, electroacupuncture produces small changes in symptoms, disability, function, dexterity and pinch strength when added to nocturnal splinting.

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“…The basis for the application of this treatment is the ability of corticosteroids to reduce swelling, thereby improving the spatial relation between the carpal tunnel and the median nerve and tendons. Some scholars demonstrated that the injection of corticosteroids into the common flexor sheath and flexor pollicis longus tendon sheath can effectively relieve pain of CTS patients, improve functional impairment, and delay the need for surgery [6,17,18,19,20]. Advancements in ultrasonography allow the visualization of the structures of the carpal tunnel, including the median nerve, flexor tendons, and the TCL as well as the structures at risk, including the ulnar artery and the proximal palmar arch.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Clinical Effectiveness of Ultrasound-Guided Corticosteroid Injection with and without Needle Release of the Transverse Carpal Ligament in Carpal Tunnel Syndrome

Guo

Xiong²,

Zhao³

et al. 2017

Eur Neurol

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Background: To compare the clinical effectiveness of ultrasound-guided corticosteroid injection with and without needle release of the transverse carpal ligament (TCL) in carpal tunnel syndrome (CTS). Methods: Between May 2014 and June 2016, 52 patients (56 wrists) with CTS were included in this study. Among these patients, 28 wrists were treated with ultrasound-guided corticosteroid injection plus needle release of the TCL (group A) and 28 wrists were treated with a single ultrasound-guided corticosteroids injection (group B). The following parameters were assessed and compared including postoperative results of procedure based on relief of symptoms, electrophysiological parameters (distal motor latency, sensory conduction velocity, and sensory nerve action potential of median nerve), and ultrasound parameters (anteroposterior diameter and cross-sectional area of the median nerve at the levels of pisiform and hamate bone, and the thicknesses of TCL on the cross-section at the level of hamate bone). Results: The overall excellent and good rate regarding the postoperative results of procedure based on the relief of symptoms at 1 month postoperatively was 82.1% in group A and 46.4% in group B (p = 0.004). There was significant difference in the above electrophysiological and ultrasound parameters between the preoperative and postoperative values in both groups (all p < 0.05). Furthermore, a significant difference was also observed in the postoperative values of the above-mentioned electrophysiological and ultrasound parameters in the 2 groups (all p < 0.05). Conclusions: Both approaches had treatment benefit in CTS. Ultrasound-guided corticosteroid injection in combination with needle release of the TCL is superior to the single ultrasound-guided corticosteroids injection.

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Methylprednisolone Injections for the Carpal Tunnel Syndrome

Abstract: Region of Scania Research and Development Foundation and Hässleholm Hospital Organization.

Cited by 101 publications

References 25 publications

Carpal tunnel syndrome

Carpal tunnel syndrome

Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial

Comparison of the Clinical Effectiveness of Ultrasound-Guided Corticosteroid Injection with and without Needle Release of the Transverse Carpal Ligament in Carpal Tunnel Syndrome

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