Evaluating the Effectiveness of Surgical Treatment and Local Steroid Injection in Patients with Carpal Tunnel Syndrome

Document Type : Original Article

Authors

1 Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran

2 Department of Neurology, Zabol University of Medical Sciences, Zabol, Iran

3 Zabol University of Medical Sciences, Zabol, Iran

4 Razavi Cancer Research Center, Razavi Hospital, Imam Reza International University, Mashhad, Iran

Abstract

Background: Carpal tunnel syndrome (CTS) is considered as the most common entrapment neuropathy. Median nerve release by surgery is a manual therapy intervention used for treating CTS.

Objectives: The aim of the present study was to compare the effectiveness of surgical decompression with respect to local steroid injection in the treatment of idiopathic.

Methods: In this study, 100 patients with mild and moderate carpal tunnel syndrome were assigned to two equal groups. In one group, patients received a single local injection of triamcinolone acetonide and in the other one, open carpal tunnel release was used. A number of variables including pain (based on Visual Analogue Scale), symptom severity and functional status (based on Bostone/ Levine symptom severity and functional status scale) were assessed at the baseline and after a 6-month follow-up. Analysis was carried by intention to treat.

Results : the severity of symptoms in the surgery and injection groups was 2.51 and 2.61 respectively. However, in the follow-up, the severity of symptoms in the surgery group (1.77) was significantly lower than the injection group (2.62) (p <0.001). Before the treatment, the mean limb function was 2.68 in the surgery group and 2.71 in the injection group. However, after the treatment, the mean performance score in the surgery group (1.74) was significantly lower than the injection group (2.58) (p<0.0001). Before the treatment, the amount of the mean pain was 5.82 in the surgery group and 5.86 in the group of injection. However, after the treatment, the mean pain score in the surgery group (0.63) was significantly lower than the injection group (1.72)(p = 0.0001).

Conclusion: The findings suggested that both local steroid injection and surgical decompression were effective in alleviating symptoms of primary CTS after a 6-month follow-up but surgery offered additional benefits. In terms of security, conservative approach to surgery was preferred.

Keywords


Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

1.Calandruccio JH. Carpal tunnel syndrome. In: Canale ST, Beaty JH, editors. Campbell's operative orthopaedics: adult spine surgery e-book. 12th ed. Philadelphia: Elsevier Health Sciences; 2013. P. 3637.
https://doi.org/10.1016/B978-0-323-07243-4.00076-1
 
2. Pauda L, Pauda R, Nuzzuro M, Tonail P. Incidence of bilateral symptoms in carpal tunnel syndrome. J Hand Surg Br. 1998;23(5):603-6. [PubMed: 9821602].
https://doi.org/10.1016/S0266-7681(98)80010-7
 
3. Rhdevik B, Lundborg G, Bagge U. Effects of graded compression on intraneural blood flow. An in vivo study on rabbit tibial nerve. J Hand Surg Am. 1981;6(1):3-12. [PubMed:7204915].
https://doi.org/10.1016/S0363-5023(81)80003-2
PMid:7204915
 
4. Chammas M, Boretto J, Burmann LM, Ramos RM, Dos Santos Abedi M et al. Razavi Int J Med. 2018
 
6(3):e14338. 5 Neto FC, et al. Carpal tunnel syndrome - Part I (anatomy, physiology, etiology and diagnosis). Rev Bras Ortop. 2014;49(5):429-36. [PubMed:26229841].
https://doi.org/10.1016/j.rboe.2014.08.001
PMid:26229841 PMCid:PMC4487499
 
5. Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, et al. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol. 2016;15(12):1273-84. [PubMed: 27751557].
https://doi.org/10.1016/S1474-4422(16)30231-9
PMid:27751557
 
6. Levine D, Simmons B, Koris M, Daltroy LH, Hohl GG, Fossel AH, et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993;75(11):1585-92. [PubMed: 8245050].
https://doi.org/10.2106/00004623-199311000-00002
PMid:8245050
 
7. Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain. 1997;72(1-2):95-7. [PubMed: 9272792].
https://doi.org/10.1016/S0304-3959(97)00005-5
PMid:9272792
 
8. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282(2):153-8. [PubMed: 10411196].
https://doi.org/10.1001/jama.282.2.153
PMid:10411196
 
9. McDiarmid M, Oliver M, Ruser J, Gucer P. Male and female rate differences in carpal tunnel syndrome injuries: personal attributes or job tasks? Environ Res. 2000;83(1):23-32. [PubMed: 10845778].
https://doi.org/10.1006/enrs.2000.4042
PMid:10845778
 
10. Shabir M. Surgical treatment of carpal tunnel syndrome. J Postgrad Med Inst. 2004;18(1):29-32.
 
11. Shiri R. Hypothyroidism and carpal tunnel syndrome: a metaanalysis. Muscle Nerve. 2014;50(6):879-83. [PubMed: 25204641].
https://doi.org/10.1002/mus.24453
PMid:25204641
 
12. Padua L, Di Pasquale A, Pazzaglia C, Liotta GA, Librante A, Mondelli M. Systematic review of pregnancy-related carpal tunnel syndrome. Muscle Nerve. 2010;42(5):697-702. [PubMed: 20976778].
https://doi.org/10.1002/mus.21910
PMid:20976778
 
13. Tang X, Zhuang L, Lu Z. Carpal tunnel syndrome: a retrospective analysis of 262 cases and a one to one matched case-control study of 61 women pairs in relationship between manual housework and carpal tunnel syndrome. Chin Med J.1999;112(1):44-8. [PubMed: 11593640].
 
14. Baysal O, Altay Z, Ozcan C, Ertem K, Yologlu S, Kayhan A. Comparison of three conservative treatment protocols in carpal tunnel syndrome. Int J Clin Pract. 2006;60(7):820-8. [PubMed: 16704676].
https://doi.org/10.1111/j.1742-1241.2006.00867.x
PMid:16704676
 
15. Ly-Pen D, Andréu JL, Millán I, de Blas G, Sánchez-Olaso A. Comparison of surgical decompression and local steroid injection in the treatment of carpal tunnel syndrome: 2-year clinical results from a randomized trial. Rheumatology. 2012;51(8):1447-54
https://doi.org/10.1093/rheumatology/kes053
PMid:22467087
 
16. Mohamed FI, Hassan A, Abdel-Magied R, Wageh R. Manual therapy intervention in the treatment of patients with carpal tunnel syndrome: median nerve mobilization versus medical treatment. Egypt Rheumatol Rehabil. 2016;43(1):27.
https://doi.org/10.4103/1110-161X.177424
 
17. Scholten RJ, Gerritsen AA, Uitdehaag BM, van Geldere D, de Vet HC, Bouter LM. Surgical treatment options for carpal tunnel syndrome. Cochrane Database Syst Rev. 2004;4:CD003905. [PubMed: 15495070].
https://doi.org/10.1002/14651858.CD003905.pub2
 
18. Ren YM, Wang XS, Wei ZJ, Fan BY, Lin W, Zhou XH, et al. Efficacy, safety, and cost of surgical versus nonsurgical treatment for carpal tunnel syndrome: a systematic review and meta-analysis. Medicine. 2016;95(40):e4857. [PubMed: PMC5059040].
https://doi.org/10.1097/MD.0000000000004857
PMid:27749538 PMCid:PMC5059040
 
19. Werner RA, Andary M. Carpal tunnel syndrome: pathophysiology and clinical neurophysiology. Clin Neurophysiol. 2002; 113(9):1373-81. [PubMed: 12169318]
https://doi.org/10.1016/S1388-2457(02)00169-4
PMid:12169318