Background Carpal tunnel syndrome is very common. It can lead to significant symptoms and loss of hand function. It also has a great socio-economic impact. However, there is no consensus regarding its best treatment up to this moment. Local steroid injection and wrist splinting are among the most popular nonsurgical treatment options. Previous studies have confirmed their respective effectiveness. Nonetheless, there is no high quality head to head comparative study regarding the two treatments in the literature. There is also no narrative data regarding the acceptance of local steroid injection in patients with carpal tunnel syndrome.
Objectives This study aims to compare the effectiveness of local steroid injection and wrist splinting for carpal tunnel syndrome, and to explore factors that influence patient acceptance of local steroid injection.
Methods We conducted a prospective randomized parallel clinical trial comparing the efficacy of local steroid injection and splinting in patients with carpal tunnel syndrome. The well validated and disease specific Boston Carpal Tunnel Questionnaire was employed and its scores at four weeks after treatment was used as the primary outcome measure. Important secondary outcomes included patient satisfaction, change of an objective finger dexterity test – 9-hole-peg test, and side effects. The qualitative study used in-depth semi-structured interviews with ten patients who refused local steroid injection. The tape-recorded interviews were transcribed, data coded and categorized and emerging themes were identified
Results Seventeen patients in the local steroid group and 8 patients in the wrist splinting group completed the study procedures. There were no statistically significant differences in the primary outcome, secondary outcomes or side effects between the two treatment groups. Subgroup analyses revealed that the clinical improvements after either local steroid injection or wrist splinting at one month were significant. Possible categories of factors for non-acceptance could be summarized into 3 main themes: (1) emotional factors (e.g. patient felt fearful when local steroid injection was suggested, and fear of injection); (2) cognitive factors (e.g. belief that local steroid injection is not a cure, and poor knowledge about local steroid injection); (3) relational factors (e.g. bad experience about steroid injection from relatives or friends, and negative comments heard from the mass media).
Conclusions Local steroid injection is an effective treatment for patients with carpal tunnel syndrome. However, its relative efficacy when compared with wrist splinting is not yet adequately studied. Patient misconceptions about local steroid injection and the disease itself are major resistances towards this useful intervention. Adequate health education and patient-doctor communication are advised.
Disclosure of Interest None declared
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