“A RANDOMIZED CONTROLLED TRIAL OF OPEN CARPAL TUNNEL RELEASE SURGERY VS LOCAL STEROID INJECTION FOR CARPAL TUNNEL SYNDROME”

Abstract

BACKGROUND: Carpal tunnel syndrome (CTS) is the most prevalent form of peripheral nerve entrapment and a leading cause of occupational impairment. Non-surgical and surgical treatment options are the two basic types of treatment. Steroid injection does not improve symptoms like surgery according to the previous researches. Nevertheless, additional research is required to further evaluate the comparative studies. OBJECTIVES: To compare the clinical and functional results of open carpal tunnel release (CTR) surgery VS local steroid injection (LSI) for carpal tunnel syndrome. METHODS: This is prospective randomized, single blind, controlled study. Forty patients who were clinically and electrophysiologically conrmed to have idiopathic CTS were enrolled in the study after informed consent. Patients were randomized and assigned into 2 groups of 20 patients each. Group-1 was managed by and Group-2 was managed by open carpal tunnel release single injection of steroid. Patients were followed every 4 weeks up to 24 week. They were assessed clinically and functionally based on Boston Carpal Tunnel Assessment Questionnaire (BCTQN). CONCLUSION: In our study we used Boston Carpal Tunnel Assessment Questionnaire (BCTQN), due to its ease of administration and responsiveness to clinical change, which can be considered as a valuable tool to evaluate functional outcome. Our ndings suggest that both local steroid injection and surgical decompression are effective treatments in alleviating symptoms in primary CTS at 24 weeks follow-up. Surgery group had statistically signicant improvement in comparison with steroid injection in terms of objective functional score in the 24 weeks followup, although clinical relevance of those differences remains to be dened. Hence we conclude, The steroid injection is a feasible non-expensive and effective therapy in most of the cases of CTS on the other hand surgical release is a day care, safe and effective treatment even in mild to moderate CTS. But cost effectiveness, cost benet analysis and surgery related morbidity should be evaluated in further clinical trials with larger sample size and longer follow up period.