Carpal tunnel syndrome study: Local corticosteroids, conversion to surgery and NHS implications

摘要

Dear Sir, Carpal tunnel syndrome (CTS) is the most common compression neuropathy, with a reported prevalence up to 16%. Management should provide prompt symptom resolution at reasonable cost to efficiently treat patients. For mild to moderate cases, guidelines recommend initial non-surgical management including splintage and/or local corticosteroid injection, reserving surgery for failed non-surgical management. We investigated local corticosteroid injection efficacy, conversion to surgery and cost-effectiveness in mild to moderate CTS treatment. The null hypothesis was that no difference would be demonstrated between patients treated by corticosteroid injection only and those treated by surgery. A retrospective study of patient records, identified by hospital database using the diagnostic search-criteria 'CTS' (December 2008-June 2010), was undertaken with additional prospective data collection and telephone contacting (October 2010-February 2011) to consolidate understanding and facilitate longer follow-up. The study inclusion criteria were adult patients with a diagnosis of primary mild or moderate CTS, who presented to the plastic surgery clinic, graded according to BSSH guidelines (Table 1). The exclusion criteria were children or those with a diagnosis of severe primary or recurrent CTS. All patients chose to receive intervention and were divided into two groups: those who began treatment with corticosteroid injection (corticosteroid-group; 1 ml Triam-cinolone acetate (10 mg/ml) + 0.5 ml 0.5% Bupivacaine) after consideration of all treatment options including splints and surgery, and those who proceeded directly to operative decompression by choice and after consideration of all treatment options including splints and local corticosteroid injection (surgery-group). Injections were administered proximal to the flexor retinaculum and ulnar to the palmaris longus tendon using a 23G needle.