LOCAL STEROID INJECTION OR CARPAL TUNNEL RELEASE FOR CARPAL TUNNEL SYNDROME - WHICH IS MORE EFFECTIVE?

Abstract

Objective: To compare the effectiveness of local steroid injection (LSI) and carpal tunnel release (CTR)operation for the treatment of carpal tunnel syndrome (CTS).

Methodology: This is a prospective randomized clinical trial conducted at Khalifa Gul Nawaz TeachingHospital and District Headquarters Teaching Hospital, Bannu from Feb. 2009 to Sept. 2011. Patientshaving CTS irrespective of gender, age and ethnicity, were included in this study. They were randomlyassigned to two treatment groups by lottery method, LSI group, and open CTR group. Follow-up was done for a total period of 12 weeks. A standardized symptoms questionnaire, the 'Global Symptom Score' (GSS)was used for baseline assessment as well as for outcome measurement. It rates symptoms on a scale from 0to 50, where '0' indicates no symptoms and '50' indicates the most severe symptoms. Data were analyzedwith SPSS 10.

Results: Out of total 40 patients, there were 11(27.5%) males and 29(72.5%) females. The age of thepatients ranged from 24-66 years (mean age 45.35+11.65). In 15 cases the age was <40 years and in 25cases the age was >40 years. Out of 40 patients, 20 were assigned to LSI group and 20 to CTR group. Thebaseline mean GSS for LSI group was 34.80+8.15 and for CTR group 35.45+7.43. Two weeks aftertreatment, mean GSS for LSI group was 11.60+6.90 and for CTR group 12.50+7.28. Four weeks aftertreatment, mean GSS for LSI group was 9.85+6.39 and for CTR group 7.30+5.68. Twelve weeks aftertreatment, mean GSS for LSI group was 22.10+6.90 and for CTR 5.45+6.90. This trend shows that LSI hastemporary effect on GSS in CTS whereas CTR has long-lasting effect.

Conclusion: LSI gives only transient relief in CTS, whereas CTR operation provides long-lasting relief asshown in this short series of 40 patients with short-term follow-up of 12 weeks.