Less-Invasive Options Fail for Carpal Tunnel, Tennis Elbow


New in the non-rheumatology journals: Neither injections for carpal tunnel syndrome or TENS for tennis elbow prove especially useful in trials. Also: Bisphosphonates and OA.

Last week's articles on rheumatology topics in the major non-rheumatology journals

Methylprednisolone Injections for the Carpal Tunnel Syndrome: A Randomized, Placebo-Controlled TrialAnnals of Internal Medicine, September 3, 2013

Methylprednisolone injections reduced the symptoms of carpal tunnel syndrome (CTS) at ten weeks, but there were no differences in symptoms after one year. There was a modest decline in surgery after one year among the methylprednisolone patients, but three-quarters did have surgery. In a Swedish trial, 111 patients with mild to moderate  carpal tunnel syndrome, for whom splinting had failed, were randomized into 80 mg methylprednisolone, 40 mg methylprednisolone, or placebo. After ten weeks, the CTS symptom severity scores (range, 1 to 5) improved by 0.64 and 0.88 points, respectively, over placebo. The trial was powered to measure a 0.8 point difference. After one year, the rates of surgery were 73%, 81%, and 92%, respectively. This is the first good-quality controlled trial to report results beyond one month, and to investigate a dose-response relationship.

Transcutaneous electrical nerve stimulation as adjunct to primary care management for tennis elbow: pragmatic randomised controlled trial (TATE trial) BMJ, September 2, 2013

A pragmatic trial of transcutaneous electrical nerve stimulation (TENS) found no evidence for benefit of TENS as an adjunct to primary care management of tennis elbow. However, adherence to exercise and TENS recommendations was low. Two hundred and forty-one participants in primary care were randomly allocated to management with or without TENS. TENS was prescribed for once a day for 45 minutes. The primary endpoint was six weeks, and both groups showed large – and similar – improvements. Only 42 participants in the TENS group met the adherence criteria.

Are Bisphosphonates Effective in the Treatment of Osteoarthritis Pain? A Meta-Analysis and Systematic Review PLoS ONE, September 4, 2013

There is limited evidence that bisphosphonates are effective in the treatment of osteoarthritis pain. A meta-analysis and systematic review found that the studies were limited by differences in duration of bisphospohonate use, dose, route of administration, and long-term data on joint structure modification. Studies were conflicting and more targeted research is necessary. But zoledronate and alendronate showed potential for managing pain in knee and hip osteoarthritis. Screening for Hepatitis C Virus Infection in Adults: U.S. Preventive Services Task Force Recommendation Statement Annals of Internal Medicine, September 3, 2013

Editorial: Expanded Hepatitis C Virus Screening Recommendations Promote Opportunities for Care and CureAnnals of Internal Medicine, September 3, 2013

The US Preventive Services Task Force (USPSTF) recommends screening for hepatitis C virus (HCV) infection in persons at high risk for infection. The USPSTF also recommends offering one-time screening for HCV infection to adults born between 1945 and 1965. (This is a B recommendation, meaning moderate evidence of moderate net benefit that outweighs the risk.) An editorial says that these expanded screening recommendations are especially important given new highly effective treatment for HCV, the increase in HCV-related mortality, the large number of people who re unaware of their infection, and a significant number of people in the “baby boomer” cohort with HCV with no reported risk factors.

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