Corticosteroid Injection as a Predictor of Outcome in Carpal Tunnel Release
Corticosteroid Injection as a Predictor of Outcome in Carpal Tunnel Release
This study will investigate whether symptomatic improvement following carpal tunnel
 corticosteroid injection can be correlated to symptomatic improvement following carpal tunnel
 release and therefore serve as a prognostic indicator.

 Clinical question: Does response to corticosteroid injection in CTS predict outcomes of
 surgical treatment?

 Secondary Questions:

 1. Can we confirm previous retrospectively collected data that a certain percentage of
 conservatively managed patients with steroid injection will avoid surgery, and that
 patients who undergo surgery will have better outcomes than those who do not.

 2. Are there differences between worker's compensation and non-worker's compensation
 patients with regard to the primary clinical question?

 3. What are Carpal Tunnel Release outcomes for the subset of patients with negative
 electrophysiologic studies?

 4. What are the outcomes of patients who undergo carpal tunnel release vs. those who choose
 not to undergo carpal tunnel release?

 A prospective cohort design study is the appropriate study design in order to measure the
 association between a predictor (response to injection) and outcome (response to surgery).
Carpal Tunnel Syndrome is a painful condition that is caused by compression of the median
 nerve in the wrist. Symptoms usually are pain, weakness, or numbness in the hand and wrist,
 radiating up the arm. Corticosteroid injections have been utilized in the conservative
 management of carpal tunnel syndrome for several decades. They have been shown to be
 relatively safe with a very low reported complication rate. Recent efforts in the literature
 have shown they are efficacious for a majority of patients although their effects are usually
 transient. Several studies have attempted to show a predictive value of corticosteroid
 injection with regard to who will ultimately benefit from carpal tunnel release. There is a
 trend towards positive predictability with several retrospective studies showing that
 patients who have a clinical benefit from steroid injection are more likely to have a
 successful outcome from carpal tunnel release. Carpal tunnel release remains the definitive
 treatment option for carpal tunnel syndrome, and a clinical test which could give the
 practitioner and patient additional information regarding likelihood of successful outcome of
 surgery would be a valuable prognostic tool.
Inclusion Criteria:

 -  Patients with a clinical diagnosis of carpal tunnel syndrome

 -  English speaking patients only

 Exclusion Criteria:

 -  Patients less than 18 years old

 -  Patients who are pregnant by patient report or intending to become pregnant during the
 study

 -  Patients unwilling or unable to return for follow-up visits prescribed by the study
 protocol.

 -  Patients who qualify for inclusion in the study, but refuse to participate.

 -  Patients with evidence of thenar atrophy on exam

 -  Patients with a diagnosis of peripheral neuropathy or other neuropathy.

 -  Patients with previous ipsilateral carpal tunnel injection or release.