Methylprednisolone for CTS (Atroshi)

Methylprednisolone injections for the carpal tunnel syndrome: a randomized, placebo-controlled trial

Atroshi I, Flondell M, Hofer M, et al. Annals of internal medicine 2013 · PMID 24026316 · doi:10.7326/0003-4819-159-5-201309030-00004

Question

Does local methylprednisolone injection reduce symptoms and the need for surgery in carpal tunnel syndrome?

Design

Three-arm double-blind placebo-controlled RCT at a single Swedish orthopaedic referral department with one-year follow-up.

Patients

Adults aged 18 to 70 with idiopathic carpal tunnel syndrome, no previous steroid injection and failed splinting.

Intervention

Methylprednisolone injection (80 mg or 40 mg)

Comparison

Saline placebo injection

Primary outcome

Change in symptom severity at 10 weeks and rate of surgery at 1 year

Key result

Methylprednisolone significantly improved symptoms at 10 weeks compared with placebo and modestly reduced the rate of surgery at one year, but most patients in all groups still went on to have surgery.

Limitations

Single centre, and all patients had already failed splinting, so results may not apply to milder primary care cases.

Impact on practice

Steroid injection gives short-term relief and can delay or avoid surgery in a minority; patients should be counselled that recurrence is common.