Intervention Review

Local corticosteroid injection for carpal tunnel syndrome

  1. Shawn C Marshall1,*,
  2. Gaetan Tardif2,
  3. Nigel L Ashworth3

Editorial Group: Cochrane Neuromuscular Disease Group

Published Online: 18 APR 2007

Assessed as up-to-date: 19 FEB 2007

DOI: 10.1002/14651858.CD001554.pub2


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.

Author Information

  1. 1

    University of Ottawa, Physical Medicine & Rehabilitation, Ottawa, Ontario, Canada

  2. 2

    Toronto Rehabilitation Institute, Division of Physiatry, Toronto, Ontario, Canada

  3. 3

    University of Alberta, Physical Medicine & Rehabilitation, Edmonton, Alberta, Canada

*Shawn C Marshall, Physical Medicine & Rehabilitation, University of Ottawa, The Rehabilitation Center, 505 Smyth Road, Ottawa, Ontario, Canada. smarshall@ottawahospital.on.ca.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 APR 2007

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

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.

Objectives

To evaluate the effectiveness of local corticosteroid injection for carpal tunnel syndrome versus placebo injection or other non-surgical interventions.

Search methods

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).

Selection criteria

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.

Main results

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).

Authors' conclusions

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

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

對腕隧症候群施予局部腎上腺皮質素注射

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。

目標

為了評估對腕隧症候群施予局部腎上腺皮質素注射與安慰劑或其他非手術療法之比較

搜尋策略

我們搜尋考科藍神經肌肉疾病(Neuromuscular Disease)群體試驗註冊目錄(2006年5月)、MEDLINE(1966年1月至2006年5月)、EMBASE(1980年1月至2006年5月)以及CINAHL(1982年1月至2006年5月)

選擇標準

隨機或準隨機研究

資料收集與分析

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)

主要結論

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)

作者結論

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,一個月之後則尚無法顯示進一步的症狀緩解。至療程後三個月內局部注射腎上腺皮質素都能提供比口服腎上腺皮質素更好的療效,不過若與抗發炎藥物及夾板治療8星期後比較,或氦氖雷射6個月後比較,則無差異。局部腎上腺皮質素注射2次在臨床並無優於1次。

翻譯人

本摘要由新光醫院吳亞縈翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

局部腎上腺皮質素注射對腕隧症候群是有短期療效的,局部腎上腺皮質素注射是治療腕隧症候群常用的非手術療法,其他非手術療法包括了手腕夾板使用、超音波及口服抗發炎藥物,手術治療也是已知的有效療法。這篇系統性回顧證實了,局部腎上腺皮質素注射對於嚴重的腕隧症候群仍有長達一個月的療效,局部注射腎上腺皮質素後三個月內也能提供比口服腎上腺皮質素更好的療效,局部腎上腺皮質素注射2次在臨床並無優於1次。我們仍需進一步研究來決定局部注射腎上腺皮質素的療效持續時間,以及此治療對於輕中度腕隧症候群是否有益。