ORAL-DRUG OF CHOICE IN CARPAL-TUNNEL SYNDROME

Background: Conservative treatment of mild to moderate carpal tunnel s yndrome (CTS) is variable. Objective: To evaluate the effectiveness of commonly used oral medications such as diuretics, nonsteroid antiinfl ammatory drugs (NSAIDs), and steroids In the treatment of CTS. Methods : Prospective, randomized, double-blind and placebo-controlled study o f patients with clinical symptoms and signs of CTS, confirmed by stand ard electrodiagnosis. Baseline assessments included a standardized sym ptom questionnaire, rating five categories of symptoms (pain, numbness , paresthesia, weakness/clumsiness, and nocturnal awakening! on a scal e from 0 (no symptoms) to 10 (severe). The total score in each of the five categories was termed the global symptom score (GSS). After basel ine assessment, patients were randomized to the following treatment ar ms: 1) 4 weeks of placebo (n = 16); 2) 4 weeks of diuretic (trichlorme thiazide, 2 mg daily; n = 16); 3) 4 weeks of NSAID-slow release (SR) ( tenoxicam-SR, 20 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 we re identical to baseline scores. The changes in GSS were analyzed to d etermine 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 be nefit.