Local corticosteroid injection for carpal tunnel syndrome
Editorial Group: Cochrane Neuromuscular Disease Group
Published Online: 21 JAN 2009
Assessed as up-to-date: 19 FEB 2007
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Marshall SC, Tardif G, Ashworth NL. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD001554. DOI: 10.1002/14651858.CD001554.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 21 JAN 2009
Carpal tunnel syndrome is a clinical syndrome manifested by signs and symptoms of irritation of the median nerve at the carpal tunnel in the wrist. Local corticosteroid injection for carpal tunnel syndrome has been studied but its effectiveness is unknown.
To evaluate the effectiveness of local corticosteroid injection for carpal tunnel syndrome versus placebo injection or other non-surgical interventions.
We searched the Cochrane Neuromuscular Disease Group Trials register (searched May 2006), MEDLINE (searched January 1966 to May 2006), EMBASE (searched January 1980 to May 2006) and CINAHL (searched January 1982 to May 2006).
Randomized or quasi-randomized studies.
Data collection and analysis
Three authors independently selected the trials and rated their overall quality. Relative risks and 95% confidence intervals were calculated for each trial and summary relative risks and 95% confidence intervals were also calculated.
We included 12 studies with altogether 671 participants. Two high quality randomized controlled trials with altogether 141 participants demonstrated clinical improvement of carpal tunnel syndrome at one month or less following local corticosteroid compared to placebo injection (relative risk 2.58 (95% confidence intervals 1.72 to 3.87)). One trial compared local corticosteroid injection to oral corticosteroid and at 12 weeks after treatment there was significantly more improvement in the injection group (mean difference -7.10 (95% confidence intervals -11.68 to -2.52)). In one trial, the rate of improvement after one month was greater after local than systemic corticosteroid injection (relative risk 3.17 (95% confidence intervals 1.02 to 9.87)). In one trial, symptoms did not improve significantly more in the injection group at eight weeks after injection compared to treatment with anti-inflammatory medication and splinting (mean difference 0.10 (95% confidence intervals -0.33 to 0.53)). Two injections versus one injection of local corticosteroid did not provide further clinical improvement, mean difference -3.80 (95% CI -9.27 to 1.67).
Local corticosteroid injection for carpal tunnel syndrome provides greater clinical improvement in symptoms one month after injection compared to placebo. Significant symptom relief beyond one month has not been demonstrated. Local corticosteroid injection provides significantly greater clinical improvement than oral corticosteroid for up to three months. Local corticosteroid injection does not significantly improve clinical outcome compared to either anti-inflammatory treatment and splinting after eight weeks or Helium-Neon laser treatment after six months. Two local corticosteroid injections do not provide significant added clinical benefit compared to one injection.
Plain language summary
Local corticosteroid injection is effective in the short-term for the treatment of carpal tunnel syndrome
Local corticosteroid injection is a common non-surgical treatment for carpal tunnel syndrome. Other non-surgical treatments include the use of wrist splints, ultrasound and oral anti-inflammatory agents. Surgical intervention is also known to be effective. This systematic review confirmed the effectiveness of local corticosteroid injection for relief of symptoms for severe carpal tunnel syndrome up to one month after injection. Local corticosteroid injection provides significantly greater clinical improvement compared to oral corticosteroid up to three months after treatment. Two injections of local corticosteroid do not provide significant further clinical improvement of symptoms. Further research is required to determine length of benefit of local corticosteroid injection and benefit for mild and moderate carpal tunnel syndrome.
腕隧症候群(carpal tunnel syndrome)是由於正中神經途經腕隧時受到刺激所引起的，對腕隧症候群施予局部腎上腺皮質素(corticosteroid)注射曾被研究但效用未知。
三位作者獨立篩選出試驗並做品質評估，計算每一個試驗及全部試驗加總的relative risks以及95%信賴區間 (confidence intervals)
我們囊括了12份研究共671位參與者，其中2份高品質的隨機對照試驗共141位參與者的研究，顯示對腕隧症候群施予局部腎上腺皮質素注射，比起注射安慰劑更能在一個月內看出臨床進步(relative risk 2.58(95% CI 1.72 to 3.87))；另一個試驗比較局部注射與口服腎上腺皮質素12週後，注射組有明顯進步(mean difference −7.10(95% CI −11.68 to −2.52))；另一個試驗於注射腎上腺皮質素後一個月評估療效，接受局部注射的比接受系統性注射的進步更多(relative risk 3.17(95% CI 1.02 to 9.87))；在一個試驗中，比較注射組與使用抗發炎藥物及夾板治療組在8星期後無明顯差異(mean difference 0.10(95% CI −0.33 to 0.53))；局部腎上腺皮質素注射2次並無優於1次(95% CI −9.27 to 1.67)
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。