A Cochrane review [Abstract] 1 included 12 studies with a total of 671 subjects. Two high quality randomized controlled trials (n=141) demonstrated clinical improvement of carpal tunnel syndrome at one month or less following local corticosteroid compared to placebo injection (RR 2.58, 95% CI 1.72 to 3.87). One trial compared local corticosteroid injection to oral steroid and at three months after treatment there was a significant improvement in the injection group (mean difference -7.00; 95% CI -11.58 to -2.42). In one trial the rate of improvement after one month was greater after local than systemic corticosteroid injection (RR 3.17, 95% CI 1.02 to 9.87). In one trial symptoms did not improve significantly for the injection group at eight weeks after injection compared to treatment with anti-inflammatory medication and splinting (mean difference 0.10, 95% CI -0.33 to 0.53). Two injections versus one injection of local corticosteroid did not provide further clinical improvement, mean difference -3.80 (95% CI -9.27 to 1.67).
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