A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Division of Neurology, Department of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China. cfhui@cuhk.edu.hk
A C F
AC
Hui
S
S
Wong
C H
CH
Leung
P
P
Tong
V
V
Mok
D
D
Poon
C W
CW
Li-Tsang
L K
LK
Wong
R
R
Boet
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects; D050824:Carpal Joints / Q000187:drug effects* / Q000503:physiopathology / Q000601:surgery*; D002349:Carpal Tunnel Syndrome / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000592:standards / Q000706:statistics & numerical data*; D004305:Dose-Response Relationship, Drug; D004333:Drug Administration Routes; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008022:Ligaments / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008475:Median Nerve / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D008775:Methylprednisolone / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology; D009431:Neural Conduction / Q000187:drug effects / Q000502:physiology; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D055502:Secondary Prevention; D013256:Steroids / Q000008:administration & dosage* / Q000009:adverse effects*; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D013256:Steroids; D008775:Methylprednisolone