The effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome: 24-month follow-up of a randomized trial

Burton, Claire; Rathod-Mistry, Trishna; Blackburn, Steven; Bucknall, Milica; Chesterton, Linda; Davenport, Graham; Dziedzic, Krysia; Higginbottom, Adele; Jowett, Sue; Myers, Helen; Oppong, Raymond; van der Windt, Danielle; Hay, Elaine; Roddy, Edward

Abstract

Objectives
This follow-up study of the INSTinCTS (INjection vs SplinTing in Carpal Tunnel Syndrome) trial compared the effects of corticosteroid injection (CSI) and night splinting (NS) for the initial management of mild-to-moderate carpal tunnel syndrome (CTS) on symptoms, resource use, and carpal tunnel surgery, over 24?months.

Methods
Adults with mild-to-moderate CTS were randomised 1:1 to a local corticosteroid injection or a night splint 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, and healthcare utilisation. A cost-utility analysis was conducted.

Results
116 participants received a CSI and 118 a NS. The response rate at 24 months was 73% in the CSI arm and 71% in the NS arm. By 24 months, a greater proportion of the CSI group had been referred for (28% vs 20%) and undergone (22% vs 16%) CTS surgery compared with the NS group. There were no statistically significant between-group differences in BCTQ score or pain NRS at 12 or 24 months. CSI was more costly (mean difference £68o59 (95% CI: -120·84, 291·24)) with fewer quality-adjusted life-years (QALYs) than NS over 24 months (mean difference -0·022 (95% CI: (-0·093, 0·045)).

Conclusion
Over 24?months, surgical intervention rates were low in both groups, but less frequent in the NS group. Whilst there were no differences in the clinical effectiveness of CSI and NS, initial treatment with CSI may not be cost-effective in the long-term compared with NS.

Citation

Burton, C., Rathod-Mistry, T., Blackburn, S., Blagojevic-Bucknall, M., Bucknall, M., Chesterton, L., …Roddy, E. (2023). The effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome: 24-month follow-up of a randomized trial. Rheumatology, 62(2), 546–554. https://doi.org/10.1093/rheumatology/keac219

• Journal Article Type: Article
• Acceptance Date: Apr 4, 2022
• Online Publication Date: Apr 8, 2022
• Publication Date: Feb 1, 2023
• Publicly Available Date: May 30, 2023
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Electronic ISSN: 1462-0332
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 62
• Issue: 2
• Pages: 546–554
• DOI: https://doi.org/10.1093/rheumatology/keac219
• Keywords: carpal tunnel syndrome; clinical trial; primary care
• Publisher URL: https://academic.oup.com/rheumatology/advance-article/doi/10.1093/rheumatology/keac219/6565312