Prognostic factors for response to treatment by corticosteroid injection or surgery in carpal tunnel syndrome (palms study): A prospective multicenter cohort study

• Published in: Muscle & nerve Vol. 60; no. 1; pp. 32 - 40
• Main Authors: Jerosch‐Herold, Christina, Shepstone, Lee, Houghton, Julie, Wilson, Edward C. F., Blake, Julian
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.07.2019; Wiley Subscription Services, Inc
• Subjects: Activities of Daily Living; Adrenal Cortex Hormones - therapeutic use; Aged; Anxiety; Anxiety - psychology; Carpal tunnel syndrome; Carpal Tunnel Syndrome - physiopathology; Carpal Tunnel Syndrome - psychology; Carpal Tunnel Syndrome - therapy; Cohort analysis; Cohort Studies; Conservative Treatment; corticosteroid injection; Corticosteroids; Decision making; Depression - psychology; Female; Humans; Injection; Injections; Male; Medical prognosis; Middle Aged; Multivariate Analysis; Muscles; Neurosurgical Procedures; outcome; Overuse injuries; Patient Reported Outcome Measures; Patients; Prognosis; prognostic factors; Prospective Studies; Quality of Life; Severity of Illness Index; Signs and symptoms; Steroids; Surgery; surgical decompression; carpal tunnel syndrome; corticosteroid injection; prognostic factors; outcome; surgical decompression
• ISSN: 0148-639X; 1097-4598
• DOI: 10.1002/mus.26459

ABSTRACT Introduction Studies of prognosis for surgery and corticosteroid injection for carpal tunnel syndrome (CTS) have considered only a limited range of explanatory variables for outcome. Methods Data were prospectively collected on patient‐reported symptoms, physical and psychological functioning, comorbidity, and quality of life at baseline and every 6 months for up to 2 years. Outcomes were patient‐rated change over a 6‐month period and symptom‐severity score at 18 months. Results In total, 754 patients with CTS completed baseline questionnaires, and 626 (83%) completed follow‐up to 18 months. Multivariable modeling identified, independent of symptom severity at outset, higher health utility, fewer comorbidities, and lower anxiety as significant predictors of better outcome from surgery. In patients treated by steroid injection, independent of symptom severity at outset, shorter duration of symptoms and having no prior injection were significant predictors of better outcome. Discussion These multivariable models of outcome may inform shared decision making about treatment for CTS. Muscle Nerve, 2019 See editorial on pages 12–13 in this issue.