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Rheumatology (Oxford). 2012 Aug;51(8):1447-54. doi: 10.1093/rheumatology/kes053. Epub 2012 Mar 30.

Comparison of surgical decompression and local steroid injection in the treatment of carpal tunnel syndrome: 2-year clinical results from a randomized trial.

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  • 1Centro de Salud Gandhi, Hospital Universitario Puerta de Hierro Majadahonda, C/Joaquín Rodrigo 2, 28222 Majadahonda, Madrid, Spain.

Abstract

OBJECTIVE:

To compare the efficacy of surgical decompression vs local steroid injection in the treatment of idiopathic CTS.

METHODS:

This is an open, prospective, randomized clinical trial. We studied the effects of surgical decompression vs local steroid injection in 163 wrists with a clinical diagnosis and neurophysiological confirmation of CTS, with an extended follow-up of 2 years. The primary end point was the percentage of wrists that reached a ≥ 20% improvement in the visual analogue scale score for nocturnal paraesthesias. Statistical analysis was done by Student's t-test for continuous variables and by chi-square test for categorical variables. Analyses were performed on an intent-to-treat basis. P < 0.05 were considered statistically significant.

RESULTS:

Both treatment groups had comparable severity of CTS at baseline. Eighty wrists were randomly assigned to surgical decompression and 83 wrists to local steroid injection. Fifty-five wrists in the surgery group and 48 wrists in the injection group completed the 2-year follow-up. In the intent-to-treat analysis, at 2-year follow-up, 60% of the wrists in the injection group vs 69% in the surgery group reached a 20% response for nocturnal paraesthesias (P < 0.001).

CONCLUSION:

Our findings suggest that both local steroid injection and surgical decompression are effective treatments in alleviating symptoms in primary CTS at 2-year follow-up. Surgery has an additional benefit in the 2-year follow-up, although clinical relevance of those differences remains to be defined.

TRIAL REGISTRATION:

Current Controlled Trials, www.controlled-trials.com, ISRCTN26264638.

PMID:
22467087
[PubMed - indexed for MEDLINE]
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