Extended Follow-up of Local Steroid Injection for Carpal Tunnel Syndrome: A Randomized Clinical Trial

Area of Science:

• Orthopedics
• Rheumatology
• Clinical Trials

Background:

• Local steroid injections are a common treatment for idiopathic carpal tunnel syndrome (CTS).
• Evidence regarding the long-term efficacy of these injections for CTS is limited.

Purpose of the Study:

• To evaluate the long-term (5-year) treatment effects of local steroid injections in patients with idiopathic CTS.
• To compare the efficacy of two methylprednisolone doses against a placebo in managing CTS symptoms and surgical intervention rates.

Main Methods:

• A 5-year extended follow-up of a double-blind, placebo-controlled randomized clinical trial.
• 111 participants with idiopathic CTS received either 80 mg methylprednisolone, 40 mg methylprednisolone, or saline placebo injections.
• Coprimary outcomes included symptom severity scores and the rate of subsequent carpal tunnel release surgery; secondary outcomes assessed pain and functional scales.

Main Results:

• No significant difference in symptom severity score changes was observed between methylprednisolone groups and placebo at 5 years.
• Subsequent surgical treatment rates were lower in the 80 mg (83.8%) and 40 mg (91.9%) methylprednisolone groups compared to placebo (97.3%).
• A statistically significant delay in the time to surgical treatment was observed for both methylprednisolone doses compared to placebo.

Conclusions:

• Local methylprednisolone injections for idiopathic carpal tunnel syndrome do not significantly improve long-term symptom severity.
• Steroid injections significantly reduce the rate of carpal tunnel release surgery and delay the need for surgical intervention.
• These findings suggest a role for local steroid injections in managing CTS by potentially postponing or avoiding surgery.