Comparison of the Efficacy of Oral and Local Steroids in the Management of Carpal Tunnel Syndrome
DOI:
https://doi.org/10.36552/pjns.v28i3.1005Abstract
Objective: This research was conducted to compare the efficacy of oral steroids with local steroid injection in the carpal tunnel as regards relieving the symptoms and improvement in neurophysiological parameters.
Materials and Methods: This study was performed at the Neurology Department, Punjab Institute of Neurosciences, Lahore. 72 patients were part of the study and divided into 2 groups; Group A (oral steroids) and B (steroid injection). Patients in Group A received a local injection of 1.5cc Normal Saline and oral prednisolone (20 mg once daily for two weeks, followed by 10 mg once daily for the next two weeks), whereas those in Group B received a local injection of 15 mg triamcinolone and an oral placebo for four weeks. The outcome was assessed using the Global Symptom Score.
Results: The average age of the patients involved in the study was 47 years. There were 33(46%) males and 39(54%) females. The mean Global Symptom Score for group A was 28.9 at baseline (0 week) and 23.5 at 4 weeks. In group B, it was found to be 27.1 at 0 week and 16.05 at 4 weeks. Independent T-test for comparing groups A and B showed a non-significant p-value at 0 week and significant at 4 weeks (p-value of 0.04).
Conclusion: The study concluded that local injection of steroids (triamcinolone) is more efficacious in improving carpal tunnel syndrome symptoms as compared to patients receiving oral steroids.
References
Chammas M, Boretto J, Burmann LM, Ramos RM, Dos Santos Neto FC, Silva JB. Carpal tunnel syndrome - Part I (anatomy, physiology, etiology and diagnosis). Rev Bras Ortop. 2014;49(5):429-36. DOI: 10.1016%2Fj.rboe.2014.08.001
Chammas M, Boretto J, Burmann LM, Ramos RM, Neto FS, Silva JB. Carpal tunnel syndrome - Part II (treatment). Rev Bras Ortop. 2014;49(5):437-45.
DOI: 10.1016%2Fj.rboe.2014.08.002
de Krom MC, Kester AD, Knipschild PG, et al. Risk
factors for carpal tunnel syndrome. Am J Epidemiol. 1990;132(6):1102-10.
Doi: 10.1093/oxfordjournals.aje.a115753
Tang CQ, Lai SW, Tay SC. Long-term outcome of carpal tunnel release surgery in patients with severe carpal tunnel syndrome. Bone & Joint J. 2017;99(10):1348-53.
DOI: 10.1302/0301-620x.99b10.bjj-2016-0587.r2
de Krom MC, Knipschild PG, Kester AD, et al. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol. 1992;45(4):373-6.
DOI: 10.1016/0895-4356(92)90038-o
Ismatullah. Local steroid injection or carpal tunnel release for carpal tunnel syndrome. Which is more effective? J Postgrad Med Inst 2013;27(2):194-9.
Zagnoli F, Andre V, Le Dreff P, et al. Idiopathic carpal tunnel syndrome. Clinical, electrodiagnostic, and magnetic resonance imaging correlations. Rev Rhum Engl Ed. 1999;66(4):192-200. PMID: 10339774
Robinson LR. Electrodiagnosis of carpal tunnel syndrome. Phys Med Rehabil Clin N Am. 2007;18(4):733-46. DOI: 10.1016/j.pmr.2007.07.008
Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement. American Association of Electrodiagnostic Medicine, American Academy of Neurology, American Academy of Physical Medicine and Rehabilitation. Muscle Nerve. 1993;16(12):1390-1. DOI: 10.1002/mus.10185.
Stevens JC. AAEM minimonograph# 26: the electrodiagnosis of carpal tunnel syndrome. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine. 1997;20(12):1477-86.
Chang MH, Lee YC, Hsieh PF. The real role of forearm mixed nerve conduction velocity in the assessment of proximal forearm conduction slowing in carpal tunnel syndrome. J Clin Neurophysiol. 2008;11:45.
DOI: 10.1016/j.clinph.2008.09.014.
Bland JD. Carpal tunnel syndrome. BMJ 2007;335(7615):343-6.
Doi: 10.1136/bmj.39282.623553.AD.
Huisstede BM, Randsdorp MS, Coert JH, Glerum S, van Middelkoop M, Koes BW. Carpal tunnel syndrome. Part II: effectiveness of surgical treatments – a systematic review. Arch Phys Med Rehabil 2010;91(7):1005-24.
DOI: 10.1016/j.apmr.2010.03.023.
Shi Q, MacDermid JC. Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? A systematic review. J Orthop Surg Res 2011;6:17. DOI: 10.1186/1749-799X-6-17.
Kumar S, Singh RJ, Reed AM, Lteif AN. Cushing’s syndrome after intra-articular and intradermal administration of triamcinolone acetonide in three pediatric patients. Pediatrics 2004;113:1820-4.
DOI: 10.1542/peds.113.6.1820.
Wong SM, Hui ACF, Tang A, et al. Local vs systemic corticosteroids in the treatment of carpal tunnel syndrome. Neurology 2001;56:1565-7.
DOI: 10.1212/wnl.56.11.1565.
Schrijver HM, Gerritsen AA, Strijers RL, et al. Correlating nerve conduction studies and clinical outcome measures on carpal tunnel syndrome: lessons from a randomized controlled trial. J Clin Neurophysiol 2005;22(3):216-21.
DOI: 10.1097/01.WNP.0000167936.75404.C3
Katz JN, Simmons BP. Carpal tunnel syndrome. N Eng J Med 2002; 346(23):1807-11.
Doi: 10.1056/NEJMcp013018.
Ferry S, Hannaford P, Warskyj M, Lewis M, Croft P. Carpal tunnel syndrome: A nested case-control study of risk factors in women. Am J Epidemiol 2000;151:566-74.
DOI: 10.1093/oxfordjournals.aje.a010244.
Chang MH, Ger LP, Hsieh PF, Huang SY. A randomised clinical trial of oral steroids in the treatment of carpal tunnel syndrome: a long term follow-up. J Neurol Neurosurg Psychiatry 2002;73(6):710-4. DOI: 10.1136/jnnp.73.6.710.
Hui ACF, Wong S, Leung CH, et al. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. Neurology 2005;64:2074-8. DOI: 10.1212/01.WNL.0000169017.79374.93.
Yang FA, Wang HY, Kuo TY, Peng CW, Liou TH, Escorpizo R, Chen HC. Injection therapy for carpal tunnel syndrome: A systematic review and network meta-analysis of randomized controlled trials. Plos one. 2024;19(5):e0303537.
https://doi.org/10.1371/journal.pone.0303537
Huisstede BM, Randsdorp MS, van den Brink J, Franke TP, Koes BW, Hoogvliet P. Effectiveness of oral pain medication and corticosteroid injections for carpal tunnel syndrome: a systematic review. Archives of physical medicine and rehabilitation. 2018;99(8):1609-22.
DOI: 10.1016/j.apmr.2018.03.003.
Adindu E, Ramtin S, Azarpey A, Ring D, Teunis T. Steroid versus placebo injections and wrist splints in patients with carpal tunnel syndrome: a systematic review and network meta-analysis. Journal of Hand Surgery (European Volume). 2024:17531934241240380.
DOI: 10.1177/17531934241240380.
Dong C, Zhu Y, Zhou J, Dong L, Hu L. Comparison of Distal and Proximal Local Steroid Injection for Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Pain and Therapy. 2022;11(4):1389-402.
DOI: 10.1007/s40122-022-00444-3.
Mino?lu M, Sucu HK, Özdemirk?ran T. Comparison of surgery and local steroid injections for the treatment of carpal tunnel syndrome: A randomized controlled trial. Neurological Sciences and Neurophysiology. 2023;40(2):64-9.
DOI: 10.4103/nsn.nsn_170_22
Cage ES, Beyer JJ, Ebraheim NA. Injections for treatment of carpal tunnel syndrome: A narrative review of the literature. Journal of Orthopaedics. 2023;37:81-5. Doi: 10.1016/j.jor.2023.02.011
Schaefer L, Maffulli N, Baroncini A, Eschweiler J, Hildebrand F, Migliorini F. Local corticosteroid injections versus surgical carpal tunnel release for carpal tunnel syndrome: systematic review and meta-analysis. Life. 2022;12(4):533.
DOI: 10.3390/life12040533
Billig JI, Sears ED. Nonsurgical treatment of carpal tunnel syndrome: a survey of hand surgeons. Plastic and Reconstructive Surgery–Global Open. 2022;10(4):e4189. DOI: 10.1097/GOX.0000000000004189
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