Carpal Tunnel - Steroid injection vs. Night Splinting Save

A prospective, pragmatic, open-label, randomized trial conducted by the UK National Health Service, studied interventions in patients with carpal tunnel syndrome (CTS) and found no advantage to either CTS corticosteroid injection (CSI) or night splinting (NS) as the initial treatment of CTS.

The INSTinCTS (INjection vs SplinTing in Carpal Tunnel Syndrome) study enrolled 234 adults with mild-to-moderate CTS and then treated them with either local corticosteroid injection or a night splinting worn for 6 weeks. Outcomes at 12 and 24 months included the Boston Carpal Tunnel Questionnaire (BCTQ), hand/wrist pain intensity numeric rating scale (NRS), the number of patients referred for and undergoing CTS surgery.

At 2 years the response rates were similar - 73% in the CSI arm and 71% in the NS arm, but there were more patients in the CSI group who were referred for (28% vs 20%) and undergone (22% vs 16%) CTS surgery. BCTQ and pain (NRS) scores were similar at 12 or 24 months. 

One in five patients ultimately required surgical intervention.  The other 80% did well with either CSI or NS, with fewer night splinting patients needing CTS surgery.