Comparison of proximal and distal corticosteroid injections for carpal tunnel syndrome.

INTRODUCTION: Evidence for the efficacy of distal corticosteroid injection compared to proximal injection in carpal tunnel syndrome is inadequate. METHODS: We conducted a randomized double-blind noninferiority trial in 131 wrists with CTS. Forty mg of methylprednisolone was injected medial to the palmaris longus tendon 2 cm proximal to the wrist crease, or at the volar aspect, 2-3 cm distal to the wrist crease. Both groups received a placebo. The primary outcome was the difference in the CTS symptom severity scale (SSS) at 1 month. Secondary outcome measures included the difference in SSS at 3 months, functional status scale (FSS) at 1 and 3 months, and the pain of injections. RESULTS: No significant differences were noted between the groups in SSS, FSS. Pain was lower in the proximal than distal group Discussion Corticosteroid injections for CTS distal to the wrist are not inferior to proximal injections, but are more painful. This article is protected by copyright. All rights reserved.