The randomized prospective study of non-surgical management of patients with mild to moderate carpel tunnel syndrome

Objective: To evaluate effectiveness of used oral medications such as diuretics, steroids and local steroid injections in the treatment of mild to moderate CTS.

Methods: Prospective randomized study of patients with clinical symptoms and signs of CTS, confirmed by standard electrodiagnosis. Baseline assessments included a standardized Boston questionnaire to assess symptom severity score, functional severity score, total score, relevant clinical examination and necessary nerve conduction studies (NCS). After the baseline assessment, patients were randomized to following treatment arms:

1. Steroid local injection (n = 64)

2. Oral steroid for 28 days (n = 64)

3. Oral steroid + diuretics for 28 days (n = 69)

Boston questionnaire symptom severity score, functional severity score, total score and the NCS results were analyzed after 28 days of treatment.

Results: Boston questionnaire scores (symptom severity score, functional severity score and total score) were significantly improved with all three treatment modalities after 4 weeks of treatment p <0.05 the values of each indicator was more or less similar in each group at the baseline.

The percentage of improvement is highest with steroid injection and lowest with oral steroids and steroids + diuretic group falling in between. Sensory nerve conduction studies showed an improvement in all three treatment modalities. But a statistically significant improvement was seen in steroid injection and oral steroid + diuretic groups only p <0.05.

Conclusion: All three treatment modalities i.e. steroid injections, oral steroids, and oral steroid and diuretics are effective in treating mild to moderate CTS. The improvement seen with steroid injection is more than that is seen in the other two interventions.