Prognostic Indicators for Recurrent Symptoms After a Single Corticosteroid Injection for Carpal Tunnel Syndrome.

Abstract

Corticosteroid injections are commonly used in the treatment of carpal tunnel syndrome in adults. This study sought to determine success rates early on and at one year postoperatively of a single corticosteroid injection while identifying prognostic indicators for symptom recurrence and repeat intervention. Fifty-four consecutive wrists in forty-nine patients with carpal tunnel syndrome treated with a single corticosteroid injection were prospectively enrolled. Demographic data and information on comorbidities were identified with a study-specific questionnaire. The Boston Carpal Tunnel Questionnaire was administered prior to injection. Patients returned to clinic at six weeks and were contacted at three, six, nine, and twelve months post-injection to determine symptom and intervention status. Kaplan-Meier analysis and Cox regression modeling were used to estimate recurrence rates and to identify predictors of symptom recurrence and repeat intervention. Fifty-four symptomatic wrists in forty-nine patients with a mean age of fifty-three years were included. Two patients (two wrists) were lost to follow-up. Patients reported symptom recurrence in thirty-one wrists at a median duration of 155 days post-injection. Nineteen wrists underwent carpal tunnel release at a median time of 181 days after the injection. No patient underwent a repeat injection. In our study, diabetic patients were at a 2.6-fold greater risk of reporting recurring symptoms within a one-year follow-up period. Survivorship free from symptom recurrence was 53% at six months and 31% at twelve months; survivorship from repeat intervention was 81% at six months and 66% at twelve months. A single injection achieved symptom relief in 79% of patients at six weeks; these results were maintained in 31% of patients at twelve months. Diabetic patients were at higher risk of symptom recurrence.