Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

The Cost-Effectiveness of Corticosteroid Injection of the Carpal Tunnel.

DeLea1,  Suzanne L., Poole1,  Janet L., Chavez-Chiang2,  Natalia, Sibbitt3,  Wilmer L., Bankhurst4,  Arthur D.

University of New Mexico, Albuquerque, NM
University of New Mexico
University of New Mexico HSC, Albuquerque, NM
University of NM Med Ctr, Albuquerque, NM


Corticosteroid injection is a useful and low-cost therapy for carpal tunnel syndrome.This randomized controlled study addressed whether two different low-cost injection techniques affected the outcomes and cost-effectiveness of carpal tunnel injections.


Prospective, randomized, controlled, single-blinded interventional trial.


Hospital outpatient musculoskeletal clinic.


64 subjects with symptomatic carpal tunnel syndrome.


64 wrists with carpal tunnel syndrome were randomized to palpation-guided anatomic carpal tunnel injection with 80 mg triamcinolone acetonide by: 1) a conventional technique, or 2) injection by a mechanical syringe, the RPD (the reciprocating procedure device) syringe. A one-needle, two-syringe technique with hydrodissection by 1% lidocaine was used.

Main Outcome Measurements:

Baseline pain by 10 cm Visual Analogue Pain Scale (10 cm VAS), procedural pain, pain at outcome (2 weeks and 6 months), responders, therapeutic duration, reinjection rates, total cost/patient/year, and cost/responder/year were determined.


Both methods reduced pains cores by greater than 50% from baseline at 2 weeks (p<0.001). Relative to the conventional method, the mechanical syringe resulted in 62% greater reduction in injection pain (p<0.02), a 68% increase in responder rate (p<0.02), 50% reduction in non-responder rate (p<0.02), 57% increase in therapeutic duration (p <0.001), a 25% increase in time to next procedure, a 36% ($43 US) reduction in cost/patient/yr for a patient treated in a physician office (p<0.001), and a 34% reduction ($33 US) in cost/patient/year for a hospital outpatient (p<0.001) as well as reduced cost/responder/year (p<0.001).

Figure 1.

Figure 2.

Figure 3.

Figure 4.


Cost-effectiveness and outcomes of corticosteroid injection for carpal tunnel syndrome can be significantly improved by using low-cost alterations in technique.

To cite this abstract, please use the following information:
DeLea, Suzanne L., Poole, Janet L., Chavez-Chiang, Natalia, Sibbitt, Wilmer L., Bankhurst, Arthur D.; The Cost-Effectiveness of Corticosteroid Injection of the Carpal Tunnel. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1567
DOI: 10.1002/art.29333

Abstract Supplement

Meeting Menu