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Lancet has published a comparative effectiveness study examining the the value of night splints (conservative treatment) vs local injection for patients with carpal tunnel syndrome.
A randomised, open-label, pragmatic trial in adults with mild or moderate carpal tunnel syndrome (new; < 6 weeks' duration) involved 234 patients randomly assigned (1:1) to either a single injection of 20 mg methylprednisolone acetate (from 40 mg/mL) or a night-resting splint to be worn for 6 weeks. The primary outcome was the overall score of the Boston Carpal Tunnel Questionnaire (BCTQ) at 6 weeks.
At 6 weeks 91% completed the trial. The BCTQ score was significantly better at 6 weeks in the corticosteroid injection group (mean 2·02 [SD 0·81]) than the night splint group (2·29 [0·75]; adjusted mean difference −0·32; 95% CI −0·48 to −0·16; p=0·0001). No adverse events were reported.
This open label study suggests that a single corticosteroid injection is superior to conservative night splinting in the management of mild or moderate carpal tunnel syndrome.