Corticosteroid injection is a recommended treatment option for carpal tunnel syndrome, before considering surgery. Nevertheless, injections remain controversial because there is strong evidence of ...only short-term benefits. This study aimed to determine the reintervention rate and to identify prognostic indicators for subsequent treatment after corticosteroid injection for carpal tunnel syndrome.
This study evaluated residents of Olmsted County treated with a corticosteroid injection for carpal tunnel syndrome between 2001 and 2010. Treatment failure was the primary outcome of interest. Two definitions for failure were examined: (1) the patient receiving subsequent procedural intervention and (2) the patient undergoing carpal tunnel release. Survival was estimated using Kaplan-Meier methods, and association of covariates with increased failure was modeled using Cox proportional hazards regression.
The study included 774 affected hands in 595 patients. The median follow-up period was 7.4 years. Reintervention was performed in 68 percent of cases, of which 63 percent resulted in eventual surgery. Injectate volume was significant for the outcome of any retreatment hazard ratio, 0.879 (95 percent CI, 0.804 to 0.96) and surgery hazard ratio, 0.906 (95 percent CI, 0.827 to 0.99). Rheumatoid arthritis was also significant in both models, with a hazard ratio of 0.627 (95 percent CI, 0.404 to 0.97) for any retreatment and 0.493 (95 percent CI, 0.292 to 0.83) for surgery.
In this cohort, 32 percent of patients did not receive subsequent treatment after a single injection, which indicates that there is a therapeutic role for corticosteroid injections in treating carpal tunnel syndrome. Further research is necessary to identify those patients who will benefit from an injection, to provide more individually tailored treatment.
Risk, III.
The concepts associated with work disability are not identical to those associated with medical disability. In addition to a worker's medical condition, the resultant functional limitations, and loss ...of participation in society, the injured or ill worker must often navigate a complex administrative system that often seems adversarial. This process is made less adversarial with the willingness to participate of knowledgeable clinicians. This article informs the interested clinician in regard to the unique aspects of work disability, including the issues of work accommodations, restrictions, and fitness for duty; prolonged work disability; and other return-to-work considerations at maximum medical improvement.
Trends in Carpal Tunnel Release in the United States Gelfman, Russell, MD, MS; Amadio, Peter C., MD
The Journal of hand surgery (American ed.),
2013, January 2013, 2013-Jan, 2013-1-00, 20130101, Volume:
38, Issue:
1
Journal Article
Objective
To compare the effectiveness of ultrasound‐guided injections to blind injections in the treatment of carpal tunnel syndrome (CTS) in a large community‐based cohort.
Methods
This study ...evaluated residents of Olmsted County, Minnesota, treated with a corticosteroid injection for CTS between 2001 and 2010. The proportion of patients receiving retreatment and the duration of retreatment‐free survival between blind and ultrasound‐guided injections were compared. Propensity score matching was used to control for confounding by indication.
Results
In the matched data set consisting of 234 (of 600) hands treated with a blind injection and 87 (of 89) ultrasound‐guided injection cases, ultrasound guidance was associated with a reduced hazard of retreatment (hazard ratio 0.59 95% confidence interval (95% CI) 0.37–0.93). In addition, ultrasound guidance was associated with 55% reduced odds of retreatment within 1 year compared to blind injections (adjusted odds ratio 0.45 95% CI 0.24–0.83).
Conclusion
This study indicates that ultrasound‐guided injections are more effective in comparison to blind injections in the treatment of CTS.
Excursion of the median nerve and the surrounding subsynovial connective tissue (SSCT) is diminished in patients with carpal tunnel syndrome (CTS). This study sought to determine if SSCT excursion ...could be utilized to predict surgical outcome. Idiopathic CTS patients were reviewed with ultrasound and electrodiagnostic tests at baseline. A speckle tracking algorithm was used to determine SSCT relative to tendon motion (shear index). Analysis of variance tests were used to compare SSCT motion with disease severity at baseline. Adjusted linear regressions were used to test the association with patient-reported outcome. A total of 90 CTS patients were analyzed and found to have an average shear index of 79% (95% confidence interval: 76.3%-81.6%). SSCT motion was lower in CTS patients with increasing electrophysiological severity (p = 0.0475). There was no significant association of pre-operative SSCT motion with symptomatic improvement (p = 0.268). Overall, SSCT motion is decreased in CTS patients, but exhibits limited correlation with clinical severity.
The optimal volume and dose of corticosteroid injections for treatment of carpal tunnel syndrome (CTS) have not yet been established. It is unknown whether the volume of injectate influences the ...outcome of carpal tunnel injection. The purpose of this study was to assess whether there is an association between the volume of injectate and subsequent intervention in the treatment of CTS.
This study evaluated residents of Olmsted County, MN, who were treated with a corticosteroid injection for CTS between 2001 and 2010. Failure of treatment was the primary outcome, defined as a subsequent intervention: either a second injection or carpal tunnel release within 1 year of initial injection. General estimating equations logistic regression was used to assess the association between injectate volume and rate of treatment failure, adjusting for age, sex, effective dose of steroid, type of steroid injected, electrodiagnostic severity, and the presence of comorbidities such as rheumatoid arthritis, diabetes mellitus, peripheral neuropathy, and radiculopathy.
There were 856 affected hands in 651 patients. A total of 56% (n = 484) of treated hands received subsequent treatment within 1 year. Multivariable analysis showed that a larger injectate volume was significantly associated with reduced rate of treatment failure within 1 year. Rheumatoid arthritis and ultrasound-guided procedures were also associated with a reduced rate of treatment failure, whereas severe electrodiagnostic results were associated with an increased rate of failure.
This study showed that a larger volume of corticosteroid injection is associated with reduced odds of subsequent intervention after a single corticosteroid injection in CTS. Further research is needed to determine the optimal volume for steroid injections in the treatment of CTS.
Prognostic IV.
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