BACKGROUND AND PURPOSE:

• Carpel Tunnel Syndrome
  • Results from entrapment of median nerve
  • Most common compression neuropathy of the arm and results in disturbed sleep
• Chesterton et al. (Lancet, 2018) evaluated the two common therapies, night splints vs corticosteroid injections

METHODS:

• Pragmatic, two-arm parallel group, open-label, randomized controlled trial (RCT)
  • INSTINCTS trial (INjection versus SplinTing in Carpal Tunnel Syndrome)
• Participants
  • Recruited from general practices and MSK treatment clinics
  • ≥18 years
  • New onset idiopathic mild or moderate carpal tunnel syndrome, present for >6 weeks
• Severity definitions
  • Mild: Intermittent paraesthesia in the distribution of the median nerve
  • Moderate: Constant paraesthesia and reversible numbness or pain
• Randomized to either
  • 20 mg methylprednisolone acetate injection (single dose)
  • night-resting splint to be worn for 6 weeks
• Primary outcome
  • Boston Carpal Tunnel Questionnaire (BCTQ) at 6 weeks
  • BCTQ: Questionnaire that asks patients about severity and functional status over a typical 24 hour period
• Economic cost-utility analysis was also performed

RESULTS:

• 118 in night splint group | 116 in corticosteroid group
  • 91% completed the BCTQ at 6 weeks
• Primary outcome: The BCTQ score was better in the corticosteroid injection group (p=0·0001)
  • Corticosteroid group: Mean score of 2.02
  • Night splint group: Mean score of 2.29
  • Adjusted mean difference −0.32 (95% C, −0.48 to −0.16)
• No serious or unexpected adverse events were reported
• Additional monitoring through 6 months
  • Some additional improvement in night splint group while injection group scores remained stable
  • Outcomes were not significantly different at that point in time
• Economic analysis
  • Injection was more expensive but also more effective
  • More rapid improvement with less time off work over several months

CONCLUSION:

• The authors conclude that a single corticosteroid injection should be the treatment of choice in mild and moderate carpel tunnel syndrome
• Corticosteroid injection was both effective from both a clinical and cost standpoint

Learn More – Primary Sources:

The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome (INSTINCTS trial): an open-label, parallel group, randomised controlled trial

Related ObG Topics: