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.
- Carpal tunnel syndrome
- clinical trial
- primary care