Question: In patients with carpal tunnel syndrome (CTS), what is the long-term effectiveness of oral steroids given for 2 weeks compared with 4 weeks?
Design: Randomized (allocation concealed), blinded (clinicians, patients, data collectors, and data analysts), placebo-controlled trial with 12-month follow-up.
Setting: A hospital in Taichung, Taiwan.
Patients: 109 patients (mean age, 46 years; 74% women) who had clinical symptoms and signs of CTS confirmed by electrodiagnostic tests. Exclusion criteria were symptom duration of <3 months; presence of fibrillation potentials or reinnervation on needle electromyography in the abductor pollicis brevis muscle; accompanying conditions such as cervical radiculopathy, proximal median neuropathy, or substantial polyneuropathy that could mimic CTS; evidence of obvious underlying causes of CTS; cognitive impairment; or recent peptic ulcer or history of steroid intolerance. 72% of patients completed the study; 100% of patients were included in the intention-to-treat analysis.
Intervention: Patients were allocated to prednisolone, 20 mg/d for 2 weeks followed by 10 mg/d for 2 weeks (n = 53), or prednisolone, 20 mg/d for 2 weeks followed by placebo for 2 weeks (n = 56).
Main outcome measures: A 10-point symptom questionnaire was used to rate symptoms (0 = no symptoms, and 10 = very severe symptoms) for each of 5 categories: pain, numbness, tingling, weakness or clumsiness, and nocturnal awakening. The total scores for each category formed a global symptom score (0 to 50 [most severe]). Patients were assessed for response to steroids: an improved response was defined as >50% reduction in the global symptom score, and marked improvement was >75% reduction in the score.
Main results: Analysis was by intention to treat. At 12 months, more patients who received the 4-week course of prednisolone had overall and marked symptom improvement than did the patients who received the 2-week regimen, but the differences did not reach significance (
Table ).
Conclusion: In patients with CTS, a 2-week course of prednisolone was as effective as a 4-week course in improving symptoms.