Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Response to Local Corticosteroid Injection In Carpal Tunnel Syndrome with Normal Electrodiagnostic Study.

Ly-Pen1,  Domingo, Andreu2,  José Luis, Millan3,  Isabel, de Blas4,  Gema, Sanchez-Olaso4,  Alberto

SERMAS. CS "Gandhi" / Hospital "Ramón y Cajal", Madrid, Spain
HU, Madrid, Spain
HU "Puerta de Hierro Majadahonda", Madrid, Spain
Hospital "Ramón y Cajal", Madrid, Spain

Background/Purpose:

Electrodiagnostic testing (EMG) has usually been defined as the gold standard in carpal tunnel syndrome (CTS) diagnosis. Nevertheless, correlation between clinical symptomatology and EMG has shown to be very poor. In fact, clinical symptoms may precede EMG changes in months or years. There are very few papers about the clinical response to treatment of clinically typical CTS, but with normal EMG.

The aim of this study is to compare the clinical response to local corticosteroid injections (LCI) in clinically typical CTS, with normal and pathologic results in EMG.

Methods:

We included patients older than 18 years, with typical symptoms of CTS (daily nocturnal pain, every night during at least 3 months). EMG was done on every patient. Wrists with abnormal EMG were randomised either to LCI or to surgical decompression. Wrists with normal EMG were rejected from our randomised study, and were treated with two LCI (two weeks between them). Follow-up was done at 3, 6 and 12 months. Primary outcome was visual analogue scale for pain (p-VAS), comparing wrists with abnormal EMG treated with LCI in our randomized clinical trial, with wrists with normal EMG that were all treated with LCI. Statistic signification was established by the Student's t test, Mann-Whitney's "U", the normal c2 test and with Yates' correction. The study was approved by the ethics committees at our centers and all patients gave written informed consent.

Results:

Forty four wrists were included in the group with normal EMG (NEMG) and 83 in the group with patologic EMG (PEMG).

Mean age was 49 years in the NEMG group and 54 years in the PEMG group (p = 0,063). The mean time of symptoms evolution was 26 weeks in the NEMG group and 38 weeks in the PEMG group (p = 0,33).

Mean p-VAS was 59 mm in the NEMG group and 42 mm in the PEMG group (p = 0,001). In the table we can see the percentage of wrists that reached a 20%, 50% and 70% reduction in p-VAS in the follow-up.

 Response 20%Response 50%Response 70%
Months361236123612
NEMG88%859081%758169%6162
PEMG96%878789%858683%7979
p0,1990,7060,9100,1860,2050,5510,0760,030,07

Conclusion:

Clinically relevant responses to local corticosteroid injections in CTS tend to be more frequent in wrists with pathologic EMG than in wrists with clinically typical symptoms of CTS, but with normal EMG.

To cite this abstract, please use the following information:
Ly-Pen, Domingo, Andreu, José Luis, Millan, Isabel, de Blas, Gema, Sanchez-Olaso, Alberto; Response to Local Corticosteroid Injection In Carpal Tunnel Syndrome with Normal Electrodiagnostic Study. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1896
DOI:

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