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Evidence-Based Medicine 2008;13:38; doi:10.1136/ebm.13.2.38
Copyright © 2008 by the BMJ Publishing Group Ltd.

EBM NOTEBOOK

Letter

Jeremy D P Bland

East Kent Hospitals; Canterbury, UK

The first 100% of the full text of this article appears below.

Dr Al-Khuraibet1 is a little more definite in his description of the role of local steroid injection in CTS than the evidence actually warrants. In fact it remains uncertain what proportion of patients who initially respond well to steroids eventually relapse because there has never been an adequate long-term follow-up study. It is possible that some patients, who would otherwise be subjected to the inconvenience and small but definite risk of surgery, will in fact never require surgery if injected. And there is no doubt that both the risk and inconvenience of local steroid injection are orders of magnitude lower than those of surgery. As there is no evidence to suggest that prior injection in any way prejudices the outcome of surgery, it seems logical to try steroids first in all early cases at least.

  1. Al-Khuraibet AJ. Commentary on "Review: local corticosteroid injection relieves symptoms in carpal tunnel syndrome." Evid Based Med 2008; 13: 16. Comment on Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev 2007; (2): CD001554.

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Response
Adnan J Al-Khuraibet
Evid. Based Med. 2008 13: 38. (in EBM notebook) [Extract] [Full Text] [PDF]

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