title: Prognostic Indicators for Recurrent Symptoms After a Single Corticosteroid Injection for Carpal Tunnel Syndrome.
abstract: BACKGROUND
  Corticosteroid injections are commonly used in the treatment of carpal tunnel syndrome in adults. This study sought to determine success rates early on and at one year postoperatively of a single corticosteroid injection while identifying prognostic indicators for symptom recurrence and repeat intervention.
  
  
  METHODS
  Fifty-four consecutive wrists in forty-nine patients with carpal tunnel syndrome treated with a single corticosteroid injection were prospectively enrolled. Demographic data and information on comorbidities were identified with a study-specific questionnaire. The Boston Carpal Tunnel Questionnaire was administered prior to injection. Patients returned to clinic at six weeks and were contacted at three, six, nine, and twelve months post-injection to determine symptom and intervention status. Kaplan-Meier analysis and Cox regression modeling were used to estimate recurrence rates and to identify predictors of symptom recurrence and repeat intervention.
  
  
  RESULTS
  Fifty-four symptomatic wrists in forty-nine patients with a mean age of fifty-three years were included. Two patients (two wrists) were lost to follow-up. Patients reported symptom recurrence in thirty-one wrists at a median duration of 155 days post-injection. Nineteen wrists underwent carpal tunnel release at a median time of 181 days after the injection. No patient underwent a repeat injection. In our study, diabetic patients were at a 2.6-fold greater risk of reporting recurring symptoms within a one-year follow-up period. Survivorship free from symptom recurrence was 53% at six months and 31% at twelve months; survivorship from repeat intervention was 81% at six months and 66% at twelve months.
  
  
  CONCLUSIONS
  A single injection achieved symptom relief in 79% of patients at six weeks; these results were maintained in 31% of patients at twelve months. Diabetic patients were at higher risk of symptom recurrence.
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail address for P.E. Blazar: pblazar@partners.org. E-mail address for W.E. Floyd: wfloyd@partners.org. E-mail address for B.E. Earp: bearp@partners.org.
authors.forename: Philip E
authors.initials: PE
authors.lastname: Blazar
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail address for P.E. Blazar: pblazar@partners.org. E-mail address for W.E. Floyd: wfloyd@partners.org. E-mail address for B.E. Earp: bearp@partners.org.
authors.forename: W Emerson
authors.initials: WE
authors.lastname: Floyd
authors.affiliation: 333 Harrison Street, Apartment #745, San Francisco, CA 94105. E-mail address: chhan902@gmail.com.
authors.forename: Carin H
authors.initials: CH
authors.lastname: Han
authors.affiliation: Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115. E-mail address: trozental@partners.org.
authors.forename: Tamara D
authors.initials: TD
authors.lastname: Rozental
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail address for P.E. Blazar: pblazar@partners.org. E-mail address for W.E. Floyd: wfloyd@partners.org. E-mail address for B.E. Earp: bearp@partners.org.
authors.forename: Brandon E
authors.initials: BE
authors.lastname: Earp
mesh_terms: D000328:Adult; D000368:Aged; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis* / Q000188:drug therapy*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D011795:Surveys and Questionnaires
chemical_list: D005938:Glucocorticoids