Clinical Question: Is an additional...

Clinical Question: Is an additional steroid injection beneficial after an initial injection for treating carpal funnel syndrome?

Setting: Outpatient (any)

reflection Design: randomized controlled trial (double-blinded)

Allocation: Concealed

Synopsis: A local steroid injection is effective in reducing symptoms of carpal underground thoroughfare syndrome, but nearly two thirds of patients disentangle symptomatic relapse. To determine the value of an additional steroid injection, the investigators enlisted 40 patients who met clinical and fortitude conduction study criteria for carpal underground thoroughfare syndrome. Eight weeks after an initial local steroid injection of 15 mg methylprednisolone (Medrol) patients randomly received (by concealed allocation assignment) another similar local injection of steroid or an equal tome of saline solution.

Patients blinded to their treatment assemblage assignment reported outcomes using a previously validated scoring rule for carpal tunnel syndrome. Follow-up occurr for all patients at 40 weeks. The sample size of 40 had an 80 percent power to discover a 50 percent improvement in the clinical score. Using intention-to-treat analysis, the clinical assessment scores at 40 weeks were similarly improved compared with baseline in as well-as; not only-but also; not only-but; not alone-but treatment groups. Electrophysiologic and functional issues also were similar in the two groups.

Bottom Line: An additional steroid injection for intermittent symptoms of carpal tunnel syndrome adds no benefit to a single injection. (Level of Evidence: 1b)

DAVID SLAWSON, MD

inquiry Reference: Wong SM, et al. Single v couple steroid injections for carpal underground thoroughfare syndrome: a randomised clinical trial. Int J Clin Pract December 2005;59:1417-21

Used with permission from Slawson D Additional steroid injections no added benefit for carpal underground thoroughfare syndrome. Accessed online January 18 2006 at: http://www.InfoPOEMs.com.

COPYRIGHT 2006 American Academy of Family Physicians

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