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From the Section of Neurology, Veterans General Hospital-Kaohsiung, Kaohsiung and Department of Neurology (Drs. Chang and Lo), National Yang-Ming Medical University; Department of Medicine (Drs. Chiang and Lee), Veterans General Hospital-Kaohsiung; and Department of Education and Medical Research (Dr. Ger), Veterans General Hospital-Kaohsiung, Taiwan.
Address correspondence and reprint requests to Dr. Ming-Hong Chang, Section of Neurology, Veterans General Hospital-Kaohsiung, No 386, Ta-Chung 1st Road, Kaohsiung, Taiwan.
Background: Conservative treatment of mild to moderate carpal tunnel syndrome (CTS) is variable.
Objective: To evaluate the effectiveness of commonly used oral medications such as diuretics, nonsteroid anti-inflammatory drugs (NSAIDs), and steroids in the treatment of CTS.
Methods: Prospective, randomized, double-blind and placebo-controlled study of patients with clinical symptoms and signs of CTS, confirmed by standard electrodiagnosis. Baseline assessments included a standardized symptom questionnaire, rating five categories of symptoms (pain, numbness, paresthesia, weakness/clumsiness, and nocturnal awakening) on a scale from 0(no symptoms) to 10 (severe). The total score in each of the five categories was termed the global symptom score (GSS). After baseline assessment, patients were randomized to the following treatment arms: 1) 4 weeks of placebo (N = 16); 2) 4 weeks of diuretic (trichlormethiazide, 2 mg daily; n = 16); 3) 4 weeks of NSAID-slow release (SR) (tenoxicam-SR, mg daily; n = 18); and 4) 2 weeks of prednisolone, 20 mg daily, followed by another 2-week dosage of 10 mg daily (n = 23). Results of follow-up assessments in the second and the fourth weeks were identical to baseline scores. The changes in GSS were analyzed to determine the statistical difference.
Results: No significant reduction from baseline GSS was seen at second, and fourth weeks in the placebo, NSAID-SR, and diuretic groups. However, the mean score at 4 weeks in the steroid group decreased significantly from a baseline of 27.9 ± 6.9 to 10 ± 7.4.
Conclusion: For patients with mild to moderate CTS who opt for conservative treatment, corticosteroids are of greater benefit.
Supported by NSC 86-2314-B-075B-012 to Ming-Hong Chang.
Received October 22, 1997. Accepted in final form April 10, 1998.
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