Long term effect of local corticosteroid injection for carpal tunnel syndrome: A relation with electrodiagnostic severity
Highlights ► The long term effect and prognostic factors of one local corticosteroid injection were assessed in 211 patients with CTS. ► A beneficial effect of more than 6 months was seen in 132 patients (63%), and longer than 12 months in 102 patients (48%). ► Only EMG severity was a predictor of o...
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| Published in | Clinical neurophysiology Vol. 123; no. 4; pp. 838 - 841 |
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| Main Authors | , , , |
| Format | Journal Article |
| Language | English |
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Oxford
Elsevier Ireland Ltd
01.04.2012
Elsevier |
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| Abstract | Highlights ► The long term effect and prognostic factors of one local corticosteroid injection were assessed in 211 patients with CTS. ► A beneficial effect of more than 6 months was seen in 132 patients (63%), and longer than 12 months in 102 patients (48%). ► Only EMG severity was a predictor of outcome. |
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| AbstractList | ► The long term effect and prognostic factors of one local corticosteroid injection were assessed in 211 patients with CTS. ► A beneficial effect of more than 6months was seen in 132 patients (63%), and longer than 12months in 102 patients (48%). ► Only EMG severity was a predictor of outcome.
Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. A local corticosteroid injection at the carpal tunnel inlet is often given to reduce the signs and symptoms. The long term effect of a local corticosteroid injection is not known yet. The aims of the study were to assess the long term effect of a local corticosteroid injection and the rognostic factors.
Assessment of 419 consecutive patients, seen between November 2004 and November 2007 at our Neurology out-patient clinic. After confirmation of the diagnosis CTS the treating neurologist decided on the patients eligibility for a local corticosteroid injection, containing 40mg methylprednisolone.
Local corticosteroid injection was given to 273 of the 419 patients with CTS (65%), 122 (29%) were treated surgically and 24 (6%) were treated by another therapy. Of the 273 patients long term follow-up was available for 211 (77%) patients. A beneficial effect of more than 6months was seen in 132 patients (63%), longer than 12months in 102 patients (48%), and longer than 18months in 71 patients (34%).
Only severity of electrodiagnostic testing was a predictor of outcome. The median time until treatment failure was 15months for mild, 5months for moderate and 4.5months for severe CTS (logrank test p=0.02).
Patients with an electrodiagnostically mild CTS (i.e., abnormal comparative tests or prolonged median DSL>3.5ms but normal median DML) are good candidates for a local steroid injection with 50% having a good long term effect for more than 15months.
This study shows that the EMG severity of CTS is an important prognostic factor for the long term effect of a local steroid injection. OBJECTIVECarpal tunnel syndrome (CTS) is a common entrapment neuropathy. A local corticosteroid injection at the carpal tunnel inlet is often given to reduce the signs and symptoms. The long term effect of a local corticosteroid injection is not known yet. The aims of the study were to assess the long term effect of a local corticosteroid injection and the rognostic factors.METHODSAssessment of 419 consecutive patients, seen between November 2004 and November 2007 at our Neurology out-patient clinic. After confirmation of the diagnosis CTS the treating neurologist decided on the patients eligibility for a local corticosteroid injection, containing 40 mg methylprednisolone.RESULTSLocal corticosteroid injection was given to 273 of the 419 patients with CTS (65%), 122 (29%) were treated surgically and 24 (6%) were treated by another therapy. Of the 273 patients long term follow-up was available for 211 (77%) patients. A beneficial effect of more than 6 months was seen in 132 patients (63%), longer than 12 months in 102 patients (48%), and longer than 18 months in 71 patients (34%). Only severity of electrodiagnostic testing was a predictor of outcome. The median time until treatment failure was 15 months for mild, 5 months for moderate and 4.5 months for severe CTS (logrank test p=0.02).CONCLUSIONPatients with an electrodiagnostically mild CTS (i.e., abnormal comparative tests or prolonged median DSL>3.5 ms but normal median DML) are good candidates for a local steroid injection with 50% having a good long term effect for more than 15 months.SIGNIFICANCEThis study shows that the EMG severity of CTS is an important prognostic factor for the long term effect of a local steroid injection. Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. A local corticosteroid injection at the carpal tunnel inlet is often given to reduce the signs and symptoms. The long term effect of a local corticosteroid injection is not known yet. The aims of the study were to assess the long term effect of a local corticosteroid injection and the rognostic factors. Assessment of 419 consecutive patients, seen between November 2004 and November 2007 at our Neurology out-patient clinic. After confirmation of the diagnosis CTS the treating neurologist decided on the patients eligibility for a local corticosteroid injection, containing 40 mg methylprednisolone. Local corticosteroid injection was given to 273 of the 419 patients with CTS (65%), 122 (29%) were treated surgically and 24 (6%) were treated by another therapy. Of the 273 patients long term follow-up was available for 211 (77%) patients. A beneficial effect of more than 6 months was seen in 132 patients (63%), longer than 12 months in 102 patients (48%), and longer than 18 months in 71 patients (34%). Only severity of electrodiagnostic testing was a predictor of outcome. The median time until treatment failure was 15 months for mild, 5 months for moderate and 4.5 months for severe CTS (logrank test p=0.02). Patients with an electrodiagnostically mild CTS (i.e., abnormal comparative tests or prolonged median DSL>3.5 ms but normal median DML) are good candidates for a local steroid injection with 50% having a good long term effect for more than 15 months. This study shows that the EMG severity of CTS is an important prognostic factor for the long term effect of a local steroid injection. Highlights ► The long term effect and prognostic factors of one local corticosteroid injection were assessed in 211 patients with CTS. ► A beneficial effect of more than 6 months was seen in 132 patients (63%), and longer than 12 months in 102 patients (48%). ► Only EMG severity was a predictor of outcome. |
| Author | Brekelmans, Geert Ngo, Quang Groeneweg, Sascha J.M Visser, Leo H |
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| Cites_doi | 10.1002/mus.10512 10.1002/14651858.CD001554.pub2 10.1136/jnnp.2007.115337 10.1136/bmj.39282.623553.AD 10.1136/bmj.319.7214.884 |
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| Keywords | Follow-up study Carpal tunnel syndrome Surgery Corticosteroid injection EMG Human Steroid Corticosteroid Nervous system diseases Compression Diseases of the osteoarticular system Electrophysiology Neuropathy Methylprednisolone Long term Electrodiagnosis Neurology Treatment Follow up study Electromyography Sign Peripheral nerve disease Diagnosis |
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| References | Dammers, Veering, Vermeulen (b0015) 1999; 319 Visser, Smidt, Lee (b0025) 2008; 79 Armstrong, Devor, Borschel, Contreras (b0005) 2004; 29 Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev 2007; 18: CD001554. Bland (b0010) 2007; 335 10.1016/j.clinph.2011.08.022_b0020 Dammers (10.1016/j.clinph.2011.08.022_b0015) 1999; 319 Visser (10.1016/j.clinph.2011.08.022_b0025) 2008; 79 Bland (10.1016/j.clinph.2011.08.022_b0010) 2007; 335 Armstrong (10.1016/j.clinph.2011.08.022_b0005) 2004; 29 |
| References_xml | – volume: 29 start-page: 82 year: 2004 end-page: 88 ident: b0005 article-title: Intracarpal steroid injection is safe and effective for short-term management of carpal tunnel syndrome publication-title: Muscle Nerve contributor: fullname: Contreras – volume: 335 start-page: 343 year: 2007 end-page: 346 ident: b0010 article-title: Carpal tunnel syndrome publication-title: BMJ contributor: fullname: Bland – volume: 319 start-page: 884 year: 1999 end-page: 886 ident: b0015 article-title: Injection with methylprednisolone proximal to the carpal tunnel: randomised double blind trial publication-title: BMJ contributor: fullname: Vermeulen – volume: 79 start-page: 63 year: 2008 end-page: 67 ident: b0025 article-title: High-resolution sonography versus EMG in the diagnosis of carpal tunnel syndrome publication-title: J Neurol Neurosurg Psychiatry contributor: fullname: Lee – volume: 29 start-page: 82 year: 2004 ident: 10.1016/j.clinph.2011.08.022_b0005 article-title: Intracarpal steroid injection is safe and effective for short-term management of carpal tunnel syndrome publication-title: Muscle Nerve doi: 10.1002/mus.10512 contributor: fullname: Armstrong – ident: 10.1016/j.clinph.2011.08.022_b0020 doi: 10.1002/14651858.CD001554.pub2 – volume: 79 start-page: 63 year: 2008 ident: 10.1016/j.clinph.2011.08.022_b0025 article-title: High-resolution sonography versus EMG in the diagnosis of carpal tunnel syndrome publication-title: J Neurol Neurosurg Psychiatry doi: 10.1136/jnnp.2007.115337 contributor: fullname: Visser – volume: 335 start-page: 343 year: 2007 ident: 10.1016/j.clinph.2011.08.022_b0010 article-title: Carpal tunnel syndrome publication-title: BMJ doi: 10.1136/bmj.39282.623553.AD contributor: fullname: Bland – volume: 319 start-page: 884 year: 1999 ident: 10.1016/j.clinph.2011.08.022_b0015 article-title: Injection with methylprednisolone proximal to the carpal tunnel: randomised double blind trial publication-title: BMJ doi: 10.1136/bmj.319.7214.884 contributor: fullname: Dammers |
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| Snippet | Highlights ► The long term effect and prognostic factors of one local corticosteroid injection were assessed in 211 patients with CTS. ► A beneficial effect of... ► The long term effect and prognostic factors of one local corticosteroid injection were assessed in 211 patients with CTS. ► A beneficial effect of more than... Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. A local corticosteroid injection at the carpal tunnel inlet is often given to reduce the signs... OBJECTIVECarpal tunnel syndrome (CTS) is a common entrapment neuropathy. A local corticosteroid injection at the carpal tunnel inlet is often given to reduce... |
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| SubjectTerms | Adrenal Cortex Hormones - administration & dosage Adrenal Cortex Hormones - therapeutic use Aged Anti-Inflammatory Agents - administration & dosage Anti-Inflammatory Agents - therapeutic use Biological and medical sciences Carpal tunnel syndrome Carpal Tunnel Syndrome - diagnosis Carpal Tunnel Syndrome - drug therapy Carpal Tunnel Syndrome - physiopathology Corticosteroid injection Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction Electrodiagnosis - methods Electrodiagnosis. Electric activity recording Electromyography EMG Endpoint Determination Female Fingers - innervation Fingers - physiology Follow-Up Studies Follow-up study Hand - physiopathology Humans Injections, Intramuscular Investigative techniques, diagnostic techniques (general aspects) Kaplan-Meier Estimate Male Medical sciences Methylprednisolone - administration & dosage Methylprednisolone - therapeutic use Middle Aged Muscular Atrophy - diagnosis Muscular Atrophy - etiology Nervous system Nervous system (semeiology, syndromes) Neurology Prognosis Sensation Disorders - diagnosis Sensation Disorders - etiology Surgery Survival Analysis |
| Title | Long term effect of local corticosteroid injection for carpal tunnel syndrome: A relation with electrodiagnostic severity |
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