Surgery vs. Local injections in Carpal Tunnel syndrome. Study in Routine Clinical Practice in a Primary Care Centre

Abstract

Background: Carpal Tunnel Syndrome (CTS) is a prevalent entrapment neuropathy that significantly impacts patients' quality of life. Traditional treatment modalities include local corticosteroid injections (I) and surgery (S), with varying degrees of efficacy reported in the literature. Despite numerous studies, the relative effectiveness of these treatments in routine clinical practice remains inadequately explored.

Objective: To compare the effectiveness of local injections versus surgery in the treatment of CTS within a primary care context, emphasizing the outcomes in a real-world clinical setting.

Methods: This prospective observational study included 160 naïve patients with idiopathic CTS treated in the 4th Sanitary Area of Madrid. Participants were allocated to receive either local injections of triamcinolone acetonide (I) or surgical treatment (S) based on patient-physician consensus. The primary outcomes measured were changes in the Visual Analogue Scale (VAS) for pain, Functional Status Scale, and Symptoms Severity Scale from baseline to 6 and 26 weeks post-treatment. Statistical significance was determined using Student's T-test and paired samples T-test.

Results: At baseline, both groups were comparable in terms of demographic and clinical characteristics. By the 6-week follow-up, the I group demonstrated a significant reduction in pain VAS (56.2, CI 50.9–61.6, p<0.001), improved functional status (1.25, CI 1.08–1.43, p<0.001), and decreased symptoms severity (1.97, CI 1.79–2.16, p<0.001) compared to the S group. However, at the 26-week follow-up, there were no significant differences between the two groups in pain VAS reduction (I: 52.8, CI 46.1–59.4 vs. S: 46.3, CI 39.3–53.3, p=0.196), functional status improvement (I: 1.16, CI 0.95–1.36 vs. S: 1.24, CI 0.99–1.48, p=0.601), or symptoms severity decrease (I: 1.88, CI 1.64–2.13 vs. S: 1.96, CI 1.70–2.21, p=0.662).

Conclusion: In the short term, local corticosteroid injections offer a significant advantage over surgery in alleviating the symptoms of CTS, as evidenced by improvements in pain, functional status, and symptoms severity. However, these differences diminish over time, with both treatments showing comparable effectiveness at 26 weeks. These findings highlight the importance of personalized treatment strategies in managing CTS and underscore the potential for early intervention in a primary care setting to effectively address this condition.