A RANDOMIZED, PROSPECTIVE AND DOSE VARIABLE (10-MG VS 40-MG) STUDY OF LOCAL METHYLPREDNISOLONE ACETATE INJECTION IN CARPAL TUNNEL SYNDROME

Background: Local corticosteroid injection therapy has been reported to have short lasting effect and high recurrence rate in management of patients with idiopathic carpal tunnel syndrome (CTS). One reason for higher relapse rate could be due to variability in the dose and type of corticosteroid preparation used.Objectives: To evaluate the efficacy of 10 mg vs 40 mg dose of local methylprednisolone acetate injection in patients with idiopathic carpal tunnel syndrome (CTS).Methods: Patients with clinical and electrophysiologically proven CTS were randomized to receive 10 mg or 40 mg of local methyl prednisolone acetate injection into the carpal tunnel. Primary outcome was satisfactory improvement in symptoms not requiring further therapy whereas secondary outcome measures were improvement in the symptom severity and functional scores and electrophysiological parameters. Clinical and electrophysiological evaluation was carried out at baseline and at 3 monthly intervals.Results: There were 58 patients, 28 (41 hands) randomized to 10-mg group and 30 (45 hands) to 40-mg group. The mean age, sex distribution, duration of disease, symptom severity score and functional scores were comparable between the two groups at the baseline. At 3 months, 22 patients in the 10 mg group and 23 patients in the 40 mg group fulfilled primary outcome whereas at 12 months 16 patients in the 10 mg group and 19 patients in the 40 mg group maintained their good response. Three patients and nineteen hands in the 40 mg one patient and sixteen hands in the 10 mg group required surgery and a second injection during the 12 months following the first injection. Secondary outcome measures symptom severity score (SSS) and functional scores (FS), distal motor latencies at wrist (DML), showed significant improvement in the 10-mg 10-8, respectively) and 40-mg group (P=0.0001,×group (P=0.0005, P=0.07, P=6.9 P=0.04, P=0.03, respectively). At 12 months, SSS, FS and DML continued to show significant improvement for the two groups (P=0.001, 0.002 and 0.0003, and 0.0004, 0.03 and 0.00002 for the 10 mg and the 40 mg groups, respectively). There were no significant differences in the response rates between the two groups both at 3 and 12 months, respectively.Conclusion: A low dose glucocorticoid injection is as effective and potentially less toxic and may be the recommended dose for injection into the CTS.Citation: Ann Rheum Dis, volume 66, supplement II, year 2007, page 237Session: Back pain, mechanical musculoskeletal problems, local soft tissue disorders