Health

corticosteroid injection or night splint?

If carpal tunnel syndrome is caused by rheumatoid arthritis or another inflammatory arthritis, treating the arthritis can reduce carpal tunnel syndrome symptoms.

Many times, there is no single cause for carpal tunnel syndrome. There may be a combination of risk factors that contribute to the development of this condition. Photo: Shutterstock.

According to an article published in Rheumatology, patients with mild to moderate carpal tunnel syndrome may benefit more from initial treatment with a night splint worn for six weeks than from receiving a local corticosteroid injection.

The analysis included 234 patients, of whom 116 received a corticosteroid injection and 118 were treated with a night splint. Outcomes were assessed at 12 and 24 months using the Boston Carpal Tunnel Questionnaire (BCTQ), hand/wrist pain severity numerical rating scale (NRS), number of patients referred for surgical treatment carpal tunnel syndrome and subjected to it, and the use of health care. The researchers also performed a cost-utility analysis.

The results show that the response rate at 24 months was 73% in the group assigned to corticosteroid injection and 71% in the group treated with night splint. At 24 months, a greater proportion of the group treated with corticosteroid injection was referred for surgery (28%) compared to the group assigned to night splint (20%). Likewise, among the patients who underwent surgical treatment, there were more patients in the group that received corticosteroid injection than in the group assigned to a night splint (22% vs. 16%). There were no statistically significant differences between groups in BCTQ or NRS pain score at 12 or 24 months.

In addition, corticosteroid injection was more expensive and led to fewer quality-adjusted life years than night splinting for 24 months.

Carpal tunnel

Carpal tunnel syndrome is due to pressure on the median nerve. The carpal tunnel is a narrow passage surrounded by bones and ligaments located in the palm of the hand. When the median nerve is compressed, symptoms can include numbness, tingling, and weakness in the hand and arm.

Wrist anatomy, health problems, and possible repetitive hand movements can all contribute to carpal tunnel syndrome.

Proper treatment often relieves tingling and numbness and restores function to the wrist and hand.

Symptoms

Symptoms of carpal tunnel syndrome usually begin progressively and include the following:

Tingling or numbness. You may feel tingling and numbness in your fingers or hand. Affected fingers are usually the thumb, index, middle, or ring fingers, but not the little finger. You may feel a sensation similar to an electric shock in these fingers.

The sensation can go from the wrist to the arm. These symptoms often occur while holding a steering wheel, phone, or newspaper, or they can wake you up while you’re sleeping.

Many people shake their hands to try to relieve symptoms. The feeling of numbness may become constant.

Soft spot. You may feel weakness in your hand and drop objects. This may be due to numbness in the hand or weakness of the thumb muscles, which also control the median nerve.

When you should see a doctor

See your health care provider if you have signs and symptoms of carpal tunnel syndrome that interfere with your normal activities and sleep patterns. Permanent nerve and muscle damage can occur without treatment.

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