Carpal tunnel syndrom
Conditions
Interventions
Patients will be randomly assigned to two treatment strategies. One strategy
consists of starting with a steroid injection proximal to the carpal tunnel
(injection group). The other strategy consist
Sponsors
Academisch Medisch Centrum
Eligibility
Age
18 Years to 99 Years
Inclusion criteria
Inclusion criteria: - 18 years or older at time of examination; - clinically suspected CTS; - symptoms being present for at least 6 weeks; - electrophysiological or sonographic confirmed CTS according to the Dutch *carpal tunnel syndrome guideline**; - treatment within 6 weeks after inclusion. - the patient can only be included for the treatment of one hand if both hands are eligible; this will be the hand with the most severe complaints or the dominant hand if both hands are equally affected. - surgery and injection are both considered as potential treatments for the CTS related symptoms**., * There is no consensus about findings with sonography in CTS. The current opinion of the DUTCH CTS study group is that a CSA of more than 11 mm2 is abnormal and thus confirms a clinical suspicion of CTS., ** Patients with secondary CTS due to a known underlying cause including, but not limited to: diabetes mellitus, rheumatoid arthritis, thyroid disease and a history of ipsilateral wrist fracture/trauma or surgery are allowed to participate in the DISTRICTS. This only if the treating physician considers both surgery and injection as effective treatments.
Exclusion criteria
Exclusion criteria: - follow-up not possible; - a previous history of surgery for CTS on the ipsilateral wrist; - an injection for CTS in the ipsilateral wrist less than one year ago; - previously participating in the DISTRICTS; - clinical or neurophysiological suggestion of another diagnosis that can influence CTS, like: - cervical radiculopathy; - cervical myelopathy; - brachial plexopathy including thoracic outlet syndrome; - mononeuropathies, such as pronator teres syndrome; - polyneuropathy, incl. Hereditary Neuropathy with Liability to Pressure Palsies; - complex regional pain syndrome. - unable to comprehend Dutch self-report questionnaires; - legally incompetent adults; - no informed consent;
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| if the treatment strategy starting with a surgical intervention results in a higher recovery rate at 18 months follow-up compared to starting treatment with a steroid injection. | — |
Secondary
| Measure | Time frame |
|---|---|
| A) time to recovery during 18 months of follow-up; B) number of patients recovered at different time points during follow-up; C) level of symptom severity at different time points during follow-up; D) hand functioning at 18 months follow-up; E) patient*s global perception of recovery at 18 months; F) patient satisfaction at 18 months; G) quality of life at 18 months; H) number of additional treatments during follow-up; I) number of adverse events during follow-up; J) use of care and health-related costs during follow-up. | — |
Countries
Netherlands
Outcome results
None listed