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Injection Versus Splinting in Carpal Tunnel Syndrome (INSTinCTS)

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ClinicalTrials.gov Identifier: NCT02038452
Recruitment Status : Completed
First Posted : January 16, 2014
Last Update Posted : June 5, 2019
Arthritis Research UK
Information provided by (Responsible Party):
Keele University

Brief Summary:

Carpal Tunnel Syndrome (CTS) is a common condition in which a nerve (known as the median nerve) is squeezed where it passes through the wrist. It can cause pain or aching, tingling or numbness in the affected hand. It may disturb sleep, or affect ability to do day to day things.

There have been several studies into the best treatment of patients with severe symptoms of CTS who are referred to a hospital for treatment. However, little is known about the best treatments for patients with mild to moderate symptoms who visit their GP but do not require hospital treatment.

The study will investigate whether a steroid injection is clinically effective in reducing symptoms and improving function in the short term (6 weeks) compared to a night splint in people consulting with mild to moderate CTS in primary care.We will study the effects of these 2 treatments over 6 weeks and at 6 months. Subject to further funding, the Study will also look at whether these 6 weeks of treatment are effective 1 year and 2 years later.

The study will take place in up to 50 GP practices and hospital clinics across the UK. Patients aged 18 and over who have been diagnosed with mild to moderate CTS which has been present for at least 6 weeks will be eligible for inclusion.

The steroid is a drug called "DepoMedrone." This drug is already widely used to treat CTS. In this study, one injection will be given. The splint is made of elastic and has an aluminium bar which sits on the palm of the hand. In this study, the splint will be worn at night for 6 weeks. Each participant will receive either a single steroid injection or a splint, and will be asked to complete up to 5 questionnaires over 2 years.

Condition or disease Intervention/treatment Phase
Carpal Tunnel Syndrome (CTS) Drug: Depo-Medrone Device: Wrist Splint Phase 4

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 234 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Randomised, Multicentre, Open Label, Parallel Group Pragmatic Clinical Trial of Local Steroid Injection Versus Night Splinting in Mild to Moderate Carpal Tunnel Syndrome (CTS)
Study Start Date : April 2014
Actual Primary Completion Date : December 31, 2016
Actual Study Completion Date : February 26, 2019

Arm Intervention/treatment
Active Comparator: Steroid Injection
Single steroid injection into Carpal Tunnel (as Depo-medrone 20mg)
Drug: Depo-Medrone
Steroid Injection

Active Comparator: Wrist Splint
Wrist splint to be worn at night
Device: Wrist Splint
Simple wrist splint
Other Name: Generic wrist splint

Primary Outcome Measures :
  1. Symptom severity and limitations in hand function as assessed by the Boston CTS questionnaire [ Time Frame: 6 weeks ]

Secondary Outcome Measures :
  1. Hand-wrist symptom intensity (0-10 numerical rating scale) [ Time Frame: 6 weeks, 6 months, 12 months 24 months ]
  2. Interrupted sleep [ Time Frame: 6 weeks, 6 months, 12 months, 24 months ]
  3. Adherence to splinting where indicated [ Time Frame: 6 weeks, 6 months, 12 months, 24 months ]
  4. Patients' perceived benefit and satisfaction with treatment [ Time Frame: 6 weeks, 6 months, 12 months, 24 months ]
  5. Impact of CTS on work and other activities (including work absence and reduction in performance measured by a 0-10 rating scale for work performance) [ Time Frame: 6 weeks, 6 months, 12 months, 24 months ]
  6. Referral for surgery [ Time Frame: 6 weeks, 6 months, 12 months, 24 months ]
  7. General health (EQ-5D-5L) [ Time Frame: 6 weeks, 6 months, 12 months, 24 months ]
  8. Health care utilisation [ Time Frame: 6 weeks, 6 months, 12 months, 24 months ]
  9. Use of co-interventions such as supplements, pain relief, etc [ Time Frame: 6 weeks, 6 months, 12 months, 24 months ]
  10. Patient incurred costs [ Time Frame: 6 weeks, 6 months, 12 months, 24 months ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Male or female aged ≥ 18 years
  • A clinical diagnosis of unilateral or bilateral CTS as made by a GP or trained clinician according to the diagnostic criteria
  • Mild (e.g. intermittent paraesthesia) or moderate (e.g. constant paraesthesia, reversible numbness and / or pain) severity CTS of idiopathic nature
  • Symptom duration of episode of at least 6 weeks
  • Written informed consent provided by the patient, prior to any trial specific procedures

Exclusion Criteria:

  • Steroid injection or night splints for CTS in the affected wrist within preceding 6 months
  • Any previous surgery on the affected wrist
  • Severe CTS exhibiting constant numbness or pain, constant sensory loss, severe thenar muscle atrophy or symptom severity which requires the patient to be referred for a surgical opinion
  • Clinical suspicion of local or systemic sepsis or infection
  • Current or previous infection of the affected wrist
  • Trauma to the affected hand requiring surgery or immobilisation in the previous 12 months
  • Unable to tolerate the study interventions
  • Unable to understand and complete self-report questionnaires written in English
  • Inter-current illness including, but not limited to:

    • poorly controlled thyroid disease
    • poorly controlled diabetes mellitus
    • vibration-induced neuropathy
    • inflammatory joint disease
    • suspected complex neurological conditions
    • any other severe medical illness which in the opinion of the local Principal Investigator (or other authorised clinical delegate) precludes trial participation
  • Pregnant or lactating females
  • Receiving anticoagulants
  • Any history of hypersensitivity to Depo-Medrone or any of its excipients
  • Allergy to any of the splint materials
  • Known abuse of drugs or alcohol
  • Involved in on-going litigation cases for their condition

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02038452

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United Kingdom
Staffordshire and Stoke on Trent Partnership NHS Trust
Newcastle under Lyme, Staffordshire, United Kingdom, ST5 1QG
Sponsors and Collaborators
Keele University
Arthritis Research UK
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Principal Investigator: Ed Roddy, Fellow RCP Keele University
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Keele University
ClinicalTrials.gov Identifier: NCT02038452    
Other Study ID Numbers: 464/11
20105 ( Other Grant/Funding Number: Arthritis Research UK )
2013-001435-48 ( EudraCT Number )
13/NW/0280 ( Other Identifier: UK NHS Research Ethics Committee )
09392969 ( Registry Identifier: ISRCTN )
First Posted: January 16, 2014    Key Record Dates
Last Update Posted: June 5, 2019
Last Verified: June 2019
Keywords provided by Keele University:
Additional relevant MeSH terms:
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Carpal Tunnel Syndrome
Pathologic Processes
Median Neuropathy
Peripheral Nervous System Diseases
Neuromuscular Diseases
Nervous System Diseases
Nerve Compression Syndromes
Cumulative Trauma Disorders
Sprains and Strains
Wounds and Injuries
Methylprednisolone Acetate
Methylprednisolone Hemisuccinate
Prednisolone acetate
Prednisolone hemisuccinate
Prednisolone phosphate
Anti-Inflammatory Agents
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Gastrointestinal Agents
Hormones, Hormone Substitutes, and Hormone Antagonists
Neuroprotective Agents