Oral drug of choice in carpal tunnel syndrome.
BACKGROUND
Conservative treatment of mild to moderate carpal tunnel syndrome (CTS) is variable.


OBJECTIVE
To evaluate the effectiveness of commonly used oral medications such as diuretics, nonsteroid anti-inflammatory drugs (NSAIDs), and steroids in the treatment of CTS.


METHODS
Prospective, randomized, double-blind and placebo-controlled study of patients with clinical symptoms and signs of CTS, confirmed by standard electrodiagnosis. Baseline assessments included a standardized symptom questionnaire, rating five categories of symptoms (pain, numbness, paresthesia, weakness/clumsiness, and nocturnal awakening) on a scale from 0 (no symptoms) to 10 (severe). The total score in each of the five categories was termed the global symptom score (GSS). After baseline assessment, patients were randomized to the following treatment arms: 1) 4 weeks of placebo (n = 16); 2) 4 weeks of diuretic (trichlormethiazide, 2 mg daily; n = 16); 3) 4 weeks of NSAID-slow release (SR) (tenoxicam-SR, 20 mg daily; n = 18); and 4) 2 weeks of prednisolone, 20 mg daily, followed by another 2-week dosage of 10 mg daily (n = 23). Results of follow-up assessments in the second and the fourth weeks were identical to baseline scores. The changes in GSS were analyzed to determine the statistical difference.


RESULTS
No significant reduction from baseline GSS was seen at second, and fourth weeks in the placebo, NSAID-SR, and diuretic groups. However, the mean score at 4 weeks in the steroid group decreased significantly from a baseline of 27.9 +/- 6.9 to 10 +/- 7.4.


CONCLUSIONS
For patients with mild to moderate CTS who opt for conservative treatment, corticosteroids are of greater benefit.
Chang
M H
MH
Veterans General Hospital-Kaohsiung, and Department of Neurology, National Yang-Ming Medical University, Taiwan.
Chiang
H T
HT
Lee
S S
SS
Ger
L P
LP
Lo
Y K
YK
D000284:Administration, Oral; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D002349:Carpal Tunnel Syndrome / Q000188:drug therapy*; D003710:Demography; D004232:Diuretics / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D000894:Anti-Inflammatory Agents, Non-Steroidal; D004232:Diuretics