title: Methylprednisolone injections for the carpal tunnel syndrome: a randomized, placebo-controlled trial.
abstract: BACKGROUND
  Steroid injections are used in idiopathic carpal tunnel syndrome (CTS), but evidence of efficacy beyond 1 month is lacking.
  
  
  OBJECTIVE
  To assess the efficacy of local methylprednisolone injections in CTS.
  
  
  METHODS
  Randomized, placebo-controlled trial. (ClinicalTrials.gov: NCT00806871).
  
  
  METHODS
  Regional referral orthopedic department in Sweden.
  
  
  METHODS
  Patients aged 18 to 70 years with CTS but no previous steroid injections.
  
  
  METHODS
  Three groups (37 patients each) received 80 mg of methylprednisolone, 40 mg of methylprednisolone, or placebo. The patients and treating surgeons were blinded.
  
  
  METHODS
  Primary end points were the change in CTS symptom severity scores at 10 weeks (range, 1 to 5) and rate of surgery at 1 year. Three patients had missing 10-week data. All patients had 1-year data.
  
  
  RESULTS
  Improvement in CTS symptom severity scores at 10 weeks was greater in patients who received 80 mg of methylprednisolone and 40 mg of methylprednisolone than in those who received placebo (difference in change from baseline, -0.64 [95% CI, -1.06 to -0.21; P = 0.003] and -0.88 [CI, -1.30 to -0.46; P < 0.001], respectively), but there were no significant differences at 1 year. The 1-year rates of surgery were 73%, 81%, and 92% in the 80-mg methylprednisolone, 40-mg methylprednisolone, and placebo groups, respectively. Compared with patients who received placebo, those who received 80 mg of methylprednisolone were less likely to have surgery (odds ratio, 0.24 [CI, 0.06 to 0.95]; P = 0.042). With time to surgery incorporated, both the 80- and 40-mg methylprednisolone groups had lower likelihood of surgery (hazard ratio, 0.46 [CI, 0.27 to 0.77; P = 0.003] and 0.57 [CI, 0.35 to 0.94; P = 0.026], respectively).
  
  
  CONCLUSIONS
  The study was conducted at 1 center, and wrist splinting had previously failed for all patients.
  
  
  CONCLUSIONS
  Methylprednisolone injections for CTS have significant benefits in relieving symptoms at 10 weeks and reducing the rate of surgery 1 year after treatment, but 3 out of 4 patients had surgery within 1 year.
  
  
  BACKGROUND
  Region of Scania Research and Development Foundation and Hässleholm Hospital Organization.
authors.forename: Isam
authors.initials: I
authors.lastname: Atroshi
authors.forename: Magnus
authors.initials: M
authors.lastname: Flondell
authors.forename: Manfred
authors.initials: M
authors.lastname: Hofer
authors.forename: Jonas
authors.initials: J
authors.lastname: Ranstam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002349:Carpal Tunnel Syndrome / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D053580:Muscle Strength; D011446:Prospective Studies; D012677:Sensation; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D008775:Methylprednisolone