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Low Dose Oral Steroids Help Relieve Carpal Tunnel Syndrome

Short-term low dose oral steroids are effective in carpal tunnel syndrome, with neither dose nor duration of treatment being key determinants of efficacy, suggest researchers in Taiwan.

This multicentre study, led by Dr M H Chang from Taichung Veterans General Hospital, Taichung, sought to determine the efficacy of a two-week and a four-week course of oral steroids for the conservative treatment of carpal tunnel syndrome.

Although the percentage improvement was found to be higher in the four-week treatment group, the difference was not significant.

Moreover, similar persistence of improvement in both treatment groups ultimately suggested there was no difference between the treatments in their long-term effects.

The researchers randomly divided 109 patients with carpal tunnel syndrome into two treatment groups. One group of 53 people received two weeks of prednisolone 20 mg daily followed by two weeks of prednisolone 10 mg daily (four-week group). The other group of 56 people received prednisolone 20 mg daily for two weeks and then placebo for two weeks.

All participants also completed symptom questionnaires rating the five major symptoms of the syndrome (numbness, pain, weakness/clumsiness, tingling and nocturnal awakening) on a scale of 0 (nil) to 10.

The resulting global symptom score was used to evaluate the efficacy of treatment, which was assessed at baseline and at one, three, six, nine and 12 months. The researchers also repeated electrodiagnosis at the end of the study to validate improvement.

In an intention to treat analysis at the end of the study, improvement in the four-week group was achieved in 66 percent of the patients after one month and in 49 percent by study end versus 48.2 percent and 35.7 percent, respectively, in the two-week group.

Fifty-one percent of the four-week group were considered treatment failures (including those lost to follow up, receiving surgery or with mild or no improvement) versus 64.3 of the two-week group.

However, persistence of improvement was 74.2 percent in the four-week versus 74.1 percent in the two-week group, suggesting no difference in the long-term effect of these treatments, the researchers note.

Moreover, efficacy analysis showed no significant difference in global symptom score reduction between the two groups.

Except for the amplitude of compound muscle action potentials, there was significant improvement in all measured variables on follow up electrodiagnosis.
J Neurol Neurosurg Psychiatry 2002;Dec;73(6):710-714. "A randomised clinical trial of oral steroids in the treatment of carpal tunnel syndrome: a long term follow up."

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