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Intervention Review

Local corticosteroid injection for carpal tunnel syndrome

  1. S Marshall,
  2. G Tardif,
  3. N Ashworth

Editorial Group: Cochrane Neuromuscular Disease Group

Published Online: 21 OCT 2002

DOI: 10.1002/14651858.CD001554


How to Cite

Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2002, Issue 4. Art. No.: CD001554. DOI: 10.1002/14651858.CD001554.

Author Information

*Dr Shawn Marshall, Assistant Professor, Physical Medicine & Rehabilitation, University of Ottawa, The Rehabilitation Center, 505 Smyth Road, Ottawa, Ontario, CANADA. smarshall@ottawahospital.on.ca.

Publication History

  1. Publication Status: Commented
  2. Published Online: 21 OCT 2002

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This is not the most recent version of the article. View current version (18 APR 2007)

 

Abstract

  1. Top of page
  2. Abstract
  3. Synopsis

Background

Carpal tunnel syndrome is a clinical syndrome manifested by signs and symptoms of irritation of the median nerve at the level of the carpal tunnel in the wrist. Local corticosteroid injection for carpal tunnel syndrome has been studied but its effectiveness and the duration of benefit of local corticosteroid injection for carpal tunnel syndrome remain unknown.

Objectives

To evaluate the effectiveness of local steroid injection for carpal tunnel syndrome versus placebo injection or other non-surgical interventions in improving clinical outcome and to determine the length of symptom relief.

Search strategy

We searched the Cochrane Neuromuscular Disease Group register (searched June 2002), MEDLINE (searched January 1966 to May 2002), EMBASE (searched January 1980 to May 2002)and CINAHL(searched January 1982 to May 2002).

Selection criteria

We included randomized or quasi-randomized studies of participants with carpal tunnel syndrome treated with local corticosteroid injection. The primary outcome measure was clinical improvement.

Data collection and analysis

Three reviewers independently selected the trials to be included rated for 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 identified nine randomized controlled trials. Four were excluded. One trial demonstrated clinical improvement of carpal tunnel syndrome at one month following local corticosteroid compared to placebo injection (Relative risk 3.83 (95% confidence intervals 1.82 to 8.05)). One trial compared local corticosteroid injection to oral steroid and at three months after treatment there was a significant improvement in the injection group (mean difference -7.00 (95% confidence intervals -11.58 to -2.42)). 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 for 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)). Although local steroid injection did provide benefit compared to Helium-Neon Laser treatment at two weeks after onset of treatment (Relative risk 0.27 (95% CI 0.09 to 0.83), this effect did not hold at six months follow-up (Relative risk 0.76 (95% confidence intervals 0.48 to 1.21).

Authors' conclusions

Local corticosteroid injection for carpal tunnel syndrome provides greater clinical improvement in symptoms one month after injection compared to placebo. Symptom relief beyond one month compared to placebo has not been demonstrated. Local corticosteroid injection provides significantly greater clinical improvement compared to oral steroid up to three months after treatment. Local corticosteroid injection does not provide improved clinical outcome compared to either anti-inflammatory treatment and splinting after eight weeks or Helium -Neon laser treatment after six months.

 

Synopsis

  1. Top of page
  2. Abstract
  3. Synopsis

Plain language summary

Local corticosteroid injection is effective 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 steroid up to three months after treatment. Further research is required to determine length of benefit of local corticosteroid injection and benefit for mild and moderate carpal tunnel syndrome.