Australian Doctor Australian Doctor 29th September 2017 | страница 8

News
Steroid beats splint for carpal tunnel
Steroid injections improve hand
dexterity, the study shows.
CLARE PAIN
STEROID injections may
have the edge over wrist
splinting for carpal tunnel
syndrome, a small prospec-
tive trial suggests.
With little evidence to
guide practice, clinicians in
Hong Kong conducted a ran-
domised trial in 50 patients
with the condition to com-
pare 20mg methylpredni-
solone against nocturnal
splinting.
After one month, both
groups of patients had
improved as measured by
the Boston Carpal Tunnel
Questionnaire (steroid injec-
tion was 0.44 points better;
splinting, 0.29 points better).
Differences in the overall
outcomes of symptoms and
function were not statisti-
cally significant, but patients
receiving a steroid injection
had higher satisfaction scores
and used less pain relief than
those in the splinting group.
There was also an improve-
ment in hand dexterity with
a steroid injection compared
with splinting.
The researchers said that,
based on the trial’s results,
they would advocate the use
of local steroid injections in
patients with mild or moder-
ate signs “for quick relief of
symptoms and restoration of
function”.
“Nocturnal wrist splint-
ing is a valid alternative,
especially for patients who
do not want an injection,”
they said.
Dr Michael Yelland, a
Brisbane GP with an inter-
est in musculoskeletal medi-
cine, said the study matched
his own clinical experience.
“It’s suggesting that ster-
oid injections are more
effective than splinting in
the short term,” he said.
“But the study needs to
be repeated with probably
double the sample size and
ongoing for 12 months.”
Dr Yelland said he usually
used splinting first for his
patients and if that failed,
he followed-up with a ster-
oid injection.
“For more severe cases,
you can use both [treat-
ments] together,” he added.
International Journal of
Rheumatic Diseases 2017;
online.
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