Comparison of the Efficacy of Carpal Tunnel Release vs. Local Steroid Injection in the Management of Mild to Moderate Carpal Tunnel Syndrome: A Clinical Trial

Jafari, Davood; Shariatzadeh, Hooman; Mazhar, Farid Najd; Babaei, Reza; Mirkazemi, Masoud; Ayazi, Nazanin

doi:10.5812/soj.58159

Cited by 1 publication

(8 citation statements)

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“…LSIs have been proposed for the diagnosis of early-stage CTS [40]. The landmarks for reaching the transverse carpal ligament are identical in the included studies [20,22,23,[29][30][31]33,35,36]. The needle is inserted on the ulnar side of the palmaris longus tendon proximal to the distal wrist crease [20,22,23,[29][30][31]33,35,36].…”

Section: Discussionmentioning

confidence: 99%

“…The landmarks for reaching the transverse carpal ligament are identical in the included studies [20,22,23,[29][30][31]33,35,36]. The needle is inserted on the ulnar side of the palmaris longus tendon proximal to the distal wrist crease [20,22,23,[29][30][31]33,35,36]. Infiltration protocols differed in terms of corticosteroid type and dose.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence from high-quality comparative clinical trials conducted on a large scale is limited. Most studies allocated patients in a random fashion [20,23,29,31,[33][34][35][36]. In some studies, patients themselves decided the allocation after informed consent [21,22,30].…”

Section: Discussionmentioning

confidence: 99%

“…Clinical symptoms suggestive of CTS such as pain, paresthesia, hypoesthesia, tingling, burning, numbness, etc., were prerequisites in the majority of the included studies [20,22,23,[29][30][31][32][33][34][35][36]. In two studies, symptoms had to be additionally confirmed by clinical tests, such as the Phalen's, Tinel's, and Durkan's tests [20,34]. The duration of symptoms before surgery was also heterogeneous.…”

Section: Discussionmentioning

confidence: 99%

“…In 2018, Klokkari et al performed a systematic review comparing the efficacy of conservative versus surgical management for CTS [19]. Since their study, more recent clinical investigations comparing LSIs versus CTR have been published [20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

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Local Corticosteroid Injections versus Surgical Carpal Tunnel Release for Carpal Tunnel Syndrome: Systematic Review and Meta-Analysis

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Maffulli

Baroncini

et al. 2022

Life

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Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. This meta-analysis compared local steroid injections (LSIs) versus carpal tunnel release (CTR) for the management of CTS. Neurophysiological parameters, patient-reported outcome measures (PROMs), and the complication rate were investigated. We hypothesized that LSIs may represent an effective and safe alternative to surgical management. Methods: This systematic review was conducted according to the 2020 PRISMA statement. All the clinical investigations comparing LSIs versus CTR for carpal tunnel syndrome were accessed. In March 2022, the following databases were accessed: Pubmed, Web of Science, Google Scholar, and Embase. No time constrains were used for the search. The risk of bias and statistical analyses were conducted using the Review Manager Software 5.3 (The Nordic Cochrane Collaboration, Copenhagen). Results: Data from 1096 procedures were retrieved. The mean follow-up was 12.3 (1 to 58) months. The mean age of the patients was 51.1 ± 4.6. Nocturnal paraesthesia (p < 0.0001) and visual analogue scale (p < 0.0001) were greater in the LSIs cohort. No difference was found in the functional (p = 0.2) and symptom (p = 0.4) subscales of the Boston Carpal Tunnel Questionnaire (BCTQ), median nerve distal motor latency (p = 0.9), median nerve motor amplitude (p = 0.7), median nerve sensory conduction velocity (p = 0.4), or median nerve sensory amplitude (p = 0.3). No difference was found in terms of minor complications (p = 0.9). No major complications were observed within the duration of follow-up. Conclusion: Both CTR and LSIs were effective and feasible in reducing symptoms of carpal tunnel syndrome. Though LSIs led to greater pain relief, this superiority was not permanent. Irrespective of the severity of the symptoms, current evidence suggests that a cycle of LSIs may be considered in patients with CTS. However, patients must be aware that LSIs may not be the definitive therapy, and CTR should be recommended.

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