Abstract
Background
The purpose of our study was to determine the rate of carpal tunnel decompression (CTD) following local corticosteroid injection for carpal tunnel syndrome (CTS), as well as identifying predictors of requiring further intervention and eventual decompression.
Methods
All patients diagnosed with CTS in our unit over a 6-year period were prospectively assessed. Patients were diagnosed using a combination of clinical presentation and nerve conduction studies. Patients were managed with open carpal tunnel decompression or corticosteroid injection. There were 1,564 consecutive patients diagnosed with CTS over the study period, of whom 824 (53%) underwent a corticosteroid injection as their primary treatment. We performed a survivorship analysis of these patients and used Kaplan–Meier survivorship methodology to determine the 5-year rate of re-intervention. Risk factors for re-intervention were also determined.
Results
The overall 5-year Kaplan–Meier rate of secondary CTD was 15% at 1 year and 33% at 5 years. The need for secondary CTD was independently associated with female gender, diabetes mellitus and positive nerve conduction studies at diagnosis.
Conclusions
Steroid injection is an appropriate treatment in carefully selected patients. Those who are female, diabetic and have neurophysiological confirmation of diagnosis have the highest risk of relapse. These results may be used to guide initial treatment and counsel patients about the risk relapse.
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References
Agarwal V, Singh R, Sachdev A, et al. A prospective study of the long-term efficacy of local methyl prednisolone acetate injection in the management of mild carpal tunnel syndrome. Rheumatology (Oxford). 2005;44:647–50.
Aroori S, Spence RA. Carpal tunnel syndrome. Ulster Med J. 2008;77:6–17.
Atroshi I, Gummesson C, Johnsson R, et al. Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome. BMC Musculoskelet Disord. 2003;4:9.
Badger SA, O’Donnell ME, Sherigar JM, et al. Open carpal tunnel release—still a safe and effective operation. Ulster Med J. 2008;77:22–4.
Bridges MJ, Robertson DC, Chuck AJ. Predicting the result of nerve conduction tests in carpal tunnel syndrome using a questionnaire. Hand Surg. 2011;16:39–42.
Brown RA, Gelberman RH, Seiler III JG, et al. Carpal tunnel release. A prospective, randomized assessment of open and endoscopic methods. J Bone Joint Surg Am. 1993;75:1265–75.
Demirci S, Kutluhan S, Koyuncuoglu HR, et al. Comparison of open carpal tunnel release and local steroid treatment outcomes in idiopathic carpal tunnel syndrome. Rheumatol Int. 2002;22:33–7.
Gelberman RH, Aronson D, Weisman MH. Carpal-tunnel syndrome. Results of a prospective trial of steroid injection and splinting. J Bone Joint Surg Am. 1980;62:1181–4.
Giannini F, Passero S, Cioni R, et al. Electrophysiologic evaluation of local steroid injection in carpal tunnel syndrome. Arch Phys Med Rehabil. 1991;72:738–42.
Gong HS, Baek GH, Oh JH, et al. Factors affecting willingness to undergo carpal tunnel release. J Bone Joint Surg Am. 2009;91:2130–6.
Green DP. Diagnostic and therapeutic value of carpal tunnel injection. J Hand Surg Am. 1984;9:850–4.
Gummesson C, Atroshi I, Ekdahl C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord. 2003;4:11.
Hui AC, Wong S, Leung CH, et al. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. Neurology. 2005;64:2074–8.
Jimenez DF, Gibbs SR, Clapper AT. Endoscopic treatment of carpal tunnel syndrome: a critical review. J Neurosurg. 1998;88:817–26.
Kamath V, Stothard J. A clinical questionnaire for the diagnosis of carpal tunnel syndrome. J Hand Surg Br. 2003;28:455–9.
Katz JN, Losina E, Amick III BC, et al. Predictors of outcomes of carpal tunnel release. Arthritis Rheum. 2001;44:1184–93.
Ly-Pen D, Andreu JL, de Blas G, et al. Surgical decompression versus local steroid injection in carpal tunnel syndrome: a one-year, prospective, randomized, open, controlled clinical trial. Arthritis Rheum. 2005;52:612–9.
Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev. 2007;CD001554.
McGrath MH. Local steroid therapy in the hand. J Hand Surg Am. 1984;9:915–21.
O’Connor D, Marshall S, Massy-Westropp N. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev. 2003;CD003219.
Phalen GS. The carpal tunnel syndrome. Instr Course Lect. 1957;14:142–8.
Phalen GS. The carpal-tunnel syndrome. Seventeen years’ experience in diagnosis and treatment of six hundred fifty-four hands. J Bone Joint Surg Am. 1966;48:211–28.
Scholten RJ, Mink vdM, Uitdehaag BM, et al. Surgical treatment options for carpal tunnel syndrome. Cochrane Database Syst Rev. 2007;CD003905.
Thoma A, Veltri K, Haines T, et al. A meta-analysis of randomized controlled trials comparing endoscopic and open carpal tunnel decompression. Plast Reconstr Surg. 2004;114:1137–46.
Thoma A, Wong VH, Sprague S, et al. A cost-utility analysis of open and endoscopic carpal tunnel release. Can J Plast Surg. 2006;14:15–20.
Turner A, Kimble F, Gulyas K, et al. Can the outcome of open carpal tunnel release be predicted?: a review of the literature. ANZ J Surg. 2010;80:50–4.
Verdugo RJ, Salinas RA, Castillo JL, et al. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev. 2008;CD001552.
Weber RA, DeSalvo DJ, Rude MJ. Five-year follow-up of carpal tunnel release in patients over age 65. J Hand Surg Am. 2010;35:207–11.
Werner RA, Andary M. Carpal tunnel syndrome: pathophysiology and clinical neurophysiology. Clin Neurophysiol. 2002;113:1373–81.
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There are no conflicts of interest, commercial associations, or intent of financial gain regarding this research for any of the authors.
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Jenkins, P.J., Duckworth, A.D., Watts, A.C. et al. Corticosteroid injection for carpal tunnel syndrome: a 5-year survivorship analysis. HAND 7, 151–156 (2012). https://doi.org/10.1007/s11552-012-9390-8
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DOI: https://doi.org/10.1007/s11552-012-9390-8