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American Association for Hand Surgery

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Corticosteroid Injection Exhibits Symptomatic Improvement in CTS Patients with Negative EMGs
Aaron R Prater, MS, Elizabeth A Washnock-Schmid, BS, Brooke G Garnica, BS, Alaa Hazime, BS, Jessi A Fore, BA and Charles S Day, MD, MBA, Henry Ford Health System, Detroit, MI

Introduction: While corticosteroid injections for carpal tunnel syndrome (CTS) are effective in patients with mild EMG readings, no literature has examined the effectiveness of injections in patients with negative EMGs. We hypothesize that patients with a negative EMG will have little symptomatic and functional improvement.

Methods: The Boston Carpal Tunnel Questionnaire (BCTQ) was administered to patients clinically diagnosed with CTS and a negative or mild EMG reading before receiving a corticosteroid injection. Re-evaluation of the patient's function and symptoms was completed at 2-weeks, 1-, 3-, and 6-months post-injection. The BCTQ comprises 11 functional (FSS) and 8 symptom status (SSS) questions. Each question uses a 5-point Likert scale, with each section scored separately. Data were analyzed via one-way ANOVA tests. A post-hoc Benjamini-Hochberg FDR p-value adjustment for multiple comparisons was used to determine significance between time points. Clinically significant improvement was defined as an MCID value >0.30. Patients that chose to undergo surgery at any point post-injection were considered to have failed treatment and were no longer administered surveys. All analyses were performed using SAS 9.4.

Results: A total of 25/29 (89.7%) recruited patients (mean age 50.77±11.66), 8 EMG-mild and 13 EMG-negative, are actively participating in this study. 4 patients were lost to follow-up; 2 patients opted for surgery at 1-month, and 1 at 2-months post-injection. Using multivariate analysis, patients with negative EMGs showed significant overall symptomatic benefits (p=0.009). Using univariate analysis, negative EMG patients showed clinically significant, symptomatic (SSS) improvement in three of four-time point comparisons from pre-injection to 2-weeks (p=0.009) to 1-month (p=0.105) to 3-months (p<0.001) and 6-months post-injection (p=0.005) (Figure 1). However, these patients showed no functional (FSS) improvement in time point comparisons from pre-injection to 2-weeks (p=0.051) to 1-month (p=0.058) and 6-months post-injection (p=0.062). Pre-injection to 3-months was clinically improved (p<0.001). No other time point comparisons elicited a notable change in SSS or FSS.

Conclusions: This data suggest corticosteroid injection for CTS evokes symptomatic improvement for negative EMG patients within the first 2-weeks post-injection and continues for up to 6-months. Although FSS values showed improvement at 3-months, significant benefits were not seen at any other time point comparisons.

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