Evidence map›Paper›PMID 30343858›Full record

Trial reportLancet (London, England)2018

The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome (INSTINCTS trial): an open-label, parallel group, randomised controlled trial.

Linda S Chesterton, Milica Blagojevic-Bucknall, Claire Burton, Krysia S Dziedzic, Graham Davenport, Sue M Jowett, Helen L Myers, Raymond Oppong, Trishna Rathod-Mistry, Danielle A van der Windt and 2 more

6 registry-linked trialsOpen access · hybridAbstract readMulticenter StudyPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Lancet (London, England), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 6 registered trials, which are not on this map. Cited by 42 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
42citing papers in PubMed, 6 pooled it
9.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02038452 phase4completednot on this map

Randomised, Multicentre, Open Label, Parallel Group Pragmatic Clinical Trial of Local Steroid Injection Versus Night Splinting in Mild to Moderate Carpal Tunnel Syndrome (CTS)

TypeinterventionalSponsorKeele UniversityRan2014 to 2019Enrolled234ConditionsCarpal Tunnel Syndrome (CTS)ArmsDepo-Medrone, Wrist Splint
NCT04245371 phase4completednot on this mapstarted 2020, after this paper: background citation

A Prospective, Randomized, Double-Blind, Cross-over Study of Lidocaine Patch 1.8% in Patients With Moderate to Severe Pain From Carpal Tunnel Syndrome

TypeinterventionalSponsorJohn Papakonstantinou, MDRan2020 to 2023Enrolled45ConditionsCarpal Tunnel SyndromeArmsLidocaine 1.8%, Placebo
NCT04460521 phase4recruitingnot on this mapstarted 2022, after this paper: background citation

The Use of N-acetylcysteine Supplementation in Addition to Night Splinting for Treatment of Mild to Moderate Carpal Tunnel Syndrome: A Randomized, Double-blind, Placebo-controlled Trial

TypeinterventionalSponsorEmily KraussRan2022 to 2026Enrolled240ConditionsCarpal Tunnel Syndrome, Hand Injuries and Disorders, Nerve Compression, SplintsArmsN-Acetyl cysteine, Wrist Splint
NCT04515966 phase4unknown statusnot on this mapstarted 2020, after this paper: background citation

Randomized Controlled Trial of Ultrasound-guided Steroid Injection Versus Wrist Splint in Patients With Carpal Tunnel Syndrome

TypeinterventionalSponsorMercy Health OhioRan2020 to 2022Enrolled70ConditionsCarpal Tunnel SyndromeArmsMethylprednisolone Injection [Solu-Medrol], wrist splint
NCT07660328 nanot yet recruitingnot on this mapstarted 2026, after this paper: background citation

Effect of Transfer Energy Capacitive and Resistive on Carpal Tunnel Syndrome Post Burn

TypeinterventionalSponsorCairo UniversityRan2026 to 2026Enrolled52ConditionsCarpal Tunnel Syndrome (CTS) Post-burnArmsTransfer Energy Capacitive and Resistive (TECAR) [ SMART TECAR }, Standard Hand Rehabilitation [ US }
NCT07692516 phase4active not recruitingnot on this mapstarted 2026, after this paper: background citation

Clinical and Economic Evaluation of Point-of-care Ultrasound-guided Infiltration for Subacromial and Carpal Tunnel Syndromes in Primary Care: a Cluster-randomized Study Protocol.

TypeinterventionalSponsorFundacio d'Investigacio en Atencio Primaria Jordi Gol i GurinaRan2026 to 2028Enrolled225ConditionsSubacromial Impingement Syndrome, Carpal Tunnel Syndrome (CTS), Pain ManagementArmsStandard Oral Treatment, Conventional Infiltration, Ultrasound-Guided Infiltration
3 · Its place in the literature

Who cites it

42 citing papers in PubMed, 6 syntheses or guidelines pooled it, 100 citations in OpenAlex.

  1. Pooled it
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  15. Carpal tunnel syndrome in primary care.Singapore medical journal · 2025
    Article
  16. Article
  17. Article
  18. The safety and accuracy of various carpal tunnel injection techniques.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2023
    Article
  19. Carpal Tunnel Syndrome: As Seen from the Perspective of the Patient.Plastic and reconstructive surgery. Global open · 2023
    Article
  20. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors at 3 institutions in 1 country.

Linda S ChestertonArthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.
Milica Blagojevic-BucknallArthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.
Claire BurtonArthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.
Krysia S DziedzicArthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.
Graham DavenportArthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.
Sue M JowettArthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK; Health Economics Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, UK.
Helen L MyersArthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK; Keele Clinical Trials Unit, Keele University, Keele, UK.
Raymond OppongArthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK; Health Economics Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, UK.
Trishna Rathod-MistryArthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.
Danielle A van der WindtArthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.
Elaine M HayArthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK; Haywood Academic Rheumatology Centre, Haywood Hospital, Staffordshire and Stoke-on-Trent Partnership NHS Trust, Stoke-on-Trent, UK.
Edward RoddyArthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK; Haywood Academic Rheumatology Centre, Haywood Hospital, Staffordshire and Stoke-on-Trent Partnership NHS Trust, Stoke-on-Trent, UK. Electronic address: e.roddy@keele.ac.uk.
Keele University · GBHaywood Community Hospital · GBUniversity of Birmingham · GB

Funding

Department of Health CAT CDRF 10-018Department of Health KMRF-2014-03-002Department of Health NIHR-IPF-2013-07-02Department of Health RP-PG-0407-10386
6 · The paper itself

Abstract

backgroundTo our knowledge, the comparative effectiveness of commonly used conservative treatments for carpal tunnel syndrome has not been evaluated previously in primary care. We aimed to compare the clinical and cost-effectiveness of night splints with a corticosteroid injection with regards to reducing symptoms and improving hand function in patients with mild or moderate carpal tunnel syndrome.

methodsWe did this randomised, open-label, pragmatic trial in adults (≥18 years) with mild or moderate carpal tunnel syndrome recruited from 25 primary and community musculoskeletal clinics and services. Patients with a new episode of idiopathic mild or moderate carpal tunnel syndrome of at least 6 weeks' duration were eligible. We randomly assigned (1:1) patients (permutated blocks of two and four by site) with an online web or third party telephone service to receive either a single injection of 20 mg methylprednisolone acetate (from 40 mg/mL) or a night-resting splint to be worn for 6 weeks. Patients and clinicians could not be masked to the intervention. The primary outcome was the overall score of the Boston Carpal Tunnel Questionnaire (BCTQ) at 6 weeks. We used intention-to-treat analysis, with multiple imputation for missing data, which was concealed to treatment group allocation. The trial is registered with the European Clinical Trials Database, number 2013-001435-48, and ClinicalTrial.gov, number NCT02038452.

findingsBetween April 17, 2014, and Dec 31, 2016, 234 participants were randomly assigned (118 to the night splint group and 116 to the corticosteroid injection group), of whom 212 (91%) completed the BCTQ at 6 weeks. The BCTQ score was significantly better at 6 weeks in the corticosteroid injection group (mean 2·02 [SD 0·81]) than the night splint group (2·29 [0·75]; adjusted mean difference -0·32; 95% CI -0·48 to -0·16; p=0·0001). No adverse events were reported.

interpretationA single corticosteroid injection shows superior clinical effectiveness at 6 weeks compared with night-resting splints, making it the treatment of choice for rapid symptom response in mild or moderate carpal tunnel syndrome presenting in primary care.

fundingArthritis Research UK.

Indexed as

InjectionsSplintsAdultAgedAnti-Inflammatory AgentsCarpal Tunnel SyndromeCost-Benefit AnalysisFemaleHumansMaleMethylprednisoloneMethylprednisolone AcetateMiddle AgedSeverity of Illness IndexSurveys and QuestionnairesTreatment OutcomeAnti-Inflammatory AgentsMethylprednisoloneMethylprednisolone Acetate

Identifiers

PMID30343858
PMCPMC6196880
OpenAlexW2896049324

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.