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

• Published in: Neurology Vol. 64; no. 12; pp. 2074 - 2078
• Main Authors: HUI, A. C. F, WONG, S, LEUNG, C. H, TONG, P, MOK, V, POON, D, LI-TSANG, C. W, WONG, L. K, BOET, R
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 28-06-2005
• Subjects: Adult; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - adverse effects; Biological and medical sciences; Carpal Joints - drug effects; Carpal Joints - physiopathology; Carpal Joints - surgery; Carpal Tunnel Syndrome - drug therapy; Carpal Tunnel Syndrome - physiopathology; Carpal Tunnel Syndrome - surgery; Decompression, Surgical - standards; Decompression, Surgical - statistics & numerical data; Dose-Response Relationship, Drug; Drug Administration Routes; Drug Administration Schedule; Female; Humans; Immunomodulators; Ligaments - pathology; Ligaments - physiopathology; Ligaments - surgery; Male; Median Nerve - drug effects; Median Nerve - pathology; Median Nerve - physiopathology; Medical sciences; Methylprednisolone - administration & dosage; Methylprednisolone - adverse effects; Middle Aged; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Muscle Weakness - etiology; Neural Conduction - drug effects; Neural Conduction - physiology; Neurology; Pharmacology. Drug treatments; Postoperative Complications - etiology; Postoperative Complications - physiopathology; Prospective Studies; Secondary Prevention; Steroids - administration & dosage; Steroids - adverse effects; Treatment Outcome; Steroid; Carpal tunnel syndrome; Compression; Nervous system diseases; Surgery; Diseases of the osteoarticular system; Peripheral nerve disease
• ISSN: 0028-3878; 1526-632X
• DOI: 10.1212/01.wnl.0000169017.79374.93

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.
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.
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.
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.