Article

OBJECTIVE: To compare the effectiveness of local steroid injection plus splinting
with that of local steroid injection alone using clinical and
electrophysiological parameters in patients with carpal tunnel syndrome (CTS).
DESIGN: Randomized controlled study with 12 weeks of follow-up. SETTING: Tertiary
care center. PARTICIPANTS: Volunteer sample of patients
(N=52) diagnosed with
CTS. INTERVENTIONS: Participants were randomly assigned to the steroid injection
group (n=26) or the steroid injection-plus-splinting group (n=26). Patients of
both groups received ultrasound-guided steroid injection with 1mL of 10mg
(10mg/mL) triamcinolone acetonide (Shincort) and 1mL of 2% lidocaine
hydrochloride (Xylocaine). Participants in the second group also wore a volar
splint in the neutral position while sleeping and also during daytime whenever
possible for the 12-week intervention period. MAIN OUTCOME MEASURES: Participants
were evaluated before the treatment and at 6 and 12 weeks after the onset of
treatment. The primary outcome measure was Boston Carpal Tunnel Questionnaire
scores. The secondary outcome measures were as follows: scores on the visual
analog scale for pain; electrophysiological parameters, including median nerve
distal motor latency, sensory nerve conduction velocity (SNCV), and compound
muscle action potential and sensory nerve action potential (SNAP) amplitudes; and
patient's subjective impression of improvement. RESULTS: At 12-week follow-up,
improvements in symptom severity and functional status scores on the Boston
Carpal Tunnel Questionnaire as well as SNCV and SNAP amplitudes were greater in
the group that received steroid injection combined with splinting than in the
group that received steroid injection alone. The between-group difference was .48
points (95% confidence interval [CI], .09-.88 points; P=.032) in the Symptom
Severity Scale score, .37 points (95% CI, .06-.67 points; P=.019) in the
Functional Status Scale score, 3.38m/s (95% CI, 0.54-6.22m/s; P=.015) in the SNCV
amplitude, and 3.21muV (95% CI, 0.00-6.46muV; P=.025) in the SNAP amplitude.
CONCLUSIONS: In people with CTS, steroid injection combined with splinting
resulted in modestly greater reduction of symptoms, superior functional recovery,
and greater improvement in nerve function at 12-week follow-up as compared with
steroid injection alone. However, these small differences are of unclear clinical
significance.
CI - Copyright (c) 2017 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS