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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Non-surgical treatment for symptomatic carpal tunnel syndrome: a randomized clinical trial comparing corticoid injection versus night splint

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  • João Carlos Belloti - Hospital Alvorada - Moema, UNIFESP, São Paulo, Brazil
  • presenting/speaker Vinícius Ynoe Moraes - Hospital Alvorada - Amil, Universidade Federal de São Paulo, São Paulo, Brazil
  • Jorge Raduan-Neto - Hospital Alvorada - Moema - Amil, UNIFESP - Universidade Federal de São Paulo, São Paulo, Brazil
  • Aldo Okamura - Hospital Alvorada - Moema - Amil, UNIFESP - Universidade Federal de São Paulo, São Paulo, Brazil
  • Marcela Fernandes - Hospital Alvorada - Moema, UNIFESP - Universidade Federal de São Paulo, São Paulo, Brazil

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1853

doi: 10.3205/19ifssh0297, urn:nbn:de:0183-19ifssh02972

Published: February 6, 2020

© 2020 Belloti et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objectives/Interrogation: There is no consensus regarding to the non-surgical treatment of carpal tunnel syndrome. Among the treatment options, local corticoid injection (CI) and/or wrist immobilization with night splint (INS) are commonly prescribed. However, there is a lack of high quality evidence comparing these two modalities of treatment. The aim of this study was to compare INS versus CI for patients with CTS.

Methods: Randomized clinical trial comparing CI versus INS for confirmed CTS with a minimum post intervention follow-up of six months. The diagnosis of CTS was established according to the Graham's criteria - CTS-6 (four or more criteria indicate CTS) with an eletroneuromiography. Patients were randomized (1:1 ratio) and allocated to either INS or CI. Clinical assessment were were performed just before the intervention, within the first week, one, three and six months after the intervention. Primary outcomes were defined as presence or absence of nocturnal paresthesia and of Boston-Levine (QB) questionnaire symptom scale. Secondary outcomes were: pain improvement assessed by visual analogue scale (VAS) and complications rates. Sample size was calculated to find a 30% (alpha, 5%; Beta, 80%) difference in the remission of nocturnal parestesia.

Results and Conclusions: From 100 eligible included patients, 95 complete the study planned follow up (45 INS and 50 CI. Corticoid injections demonstrated to be superior to INS in the remission of nocturnal paresthesia (remission rates at 1 month, 84.6% vs. 43.83%, p=0,001; 3 month, 71.1% vs. 40.4%, p=0,00001; 6 month, 80.3% vs. 28.8%, p=0.0001). Boston-Levine scale results were higher for INS compared to CI (42.2 vs 32.7, p=0.001 at 1 month; 46.7 vs. 32.3, p=0.0001 at 3 months; and 51.4 vs. 32.3, p=0.001 at 6 months, for INS and CI arms respectively). VAS scores were lower for CI group compared to INS. Both groups presented no complications. We conclude that CI is superior to INS for improving carpal tunnel syndrome related nocturnal paresthesia and severe symptoms. We also report that both interventions were found to be safe with no complications were reported.