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Am Fam Physician. 1999;59(1):166

Oral medications are often used to treat patients with carpal tunnel syndrome to try to decrease the swelling that traps the median nerve against the flexor retinaculum. Chang and colleagues conducted a placebo-controlled, double-blind study to compare the effectiveness of oral steroids, nonsteroidal anti-inflammatory drugs (NSAIDs) and diuretics in the treatment of patients with mild to moderate carpal tunnel syndrome.

The study included 73 patients who were randomized to receive a four-week course of a diuretic (2 mg of trichlormethiazide daily), a long-acting NSAID (20 mg of a sustained-release form daily), a steroid (20 mg daily for two weeks, followed by 10 mg daily for two weeks) or placebo. All of the patients had evidence of mild to moderate carpal tunnel syndrome on electrodiagnostic testing. There were 16 patients each in the placebo and diuretic groups, 18 patients in the NSAID group and 23 patients in the steroid group. Patients rated their pain, numbness, paresthesias, weakness and clumsiness, and nocturnal awakening from zero (no symptoms) to 10 (severe symptoms).

At the completion of the study, only the patients in the steroid group were found to show significant symptomatic improvement. The benefit was significant after two weeks of treatment but became more pronounced after four weeks. In the steroid group, global symptom scores dropped from a mean score of 27.9 (± 6.9) at the beginning of the study to a mean of 10.0 (± 7.5) at the end of the study. Scores were virtually unchanged in the placebo group.

The authors conclude that the use of short-term steroids provides greater relief of symptoms of mild to moderate carpal tunnel syndrome than NSAIDs and diuretics. They note that further studies are needed to determine whether steroid therapy produces long-term relief of symptoms, whether symptoms recur after steroids are discontinued, whether two weeks or four weeks of therapy is optimal and whether low-dose short-term steroid therapy compares with conservative approaches such as splinting and local steroid injections.

editor's note: Although steroids were found to significantly reduce symptoms in this study, the confidence intervals were large. Therefore, a larger study is needed to determine the degree of improvement.—c.c.k.

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