Predictors and Variation in Steroid Injection Use for Carpal Tunnel Syndrome from a Multicenter Quality Collaborative

Abstract

Background: Steroid injections are commonly used as first-line treatment for carpal tunnel syndrome (CTS); however, research has shown that their benefit is generally short-term and many patients go on to receive carpal tunnel release. The study purpose was to determine the variation in steroid injection use by hand surgeons. Methods: We analyzed data from a 9-center hand surgery quality collaborative. Data from 1,586 patients (2,381 hands) were included if they underwent elective CTR at one of the sites. Mixed effects logistic regression models were used to examine the association of receipt of steroid injection and association of receipt of more than one steroid injection among patient-level covariates. Results: Steroid injection use significantly varied by practice, ranging from 12-53% of patients. The odds of receiving a steroid injection were 1.4 times higher for females (p<0.01), 1.6 times higher for patients with chronic pain syndrome (p<0.01), 0.5 times lower for patients with moderate electromyography (EMG) and 0.4 times lower for patients with severe EMG classification (both p<0.01). Patients with high CTS-6 scores (p=0.02) and patients with moderate (p=0.04) or severe EMG (p=0.05) had lower odds of receiving multiple steroid injections. Complete symptomatic improvement after steroid injection was significantly reported by patients with high CTS-6 score (p=0.03) or patients with severe EMG classification (p=0.02). Conclusions: We found wide patient-level and practice-level variation in the use of steroid injections prior to undergoing CTR. These findings underscore the need for improved data and standard practice guidelines regarding which patients benefit from steroid injection.