Intra-Carpal Injection of Ketorolac Compared with Triamcinolone for Carpal Tunnel Syndrome; A Randomized Controlled Trial

Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity that can be treated with surgical and non-surgical methods. Ketorolac, a nonsteroidal anti-inflammatory drug, is commonly used for musculoskeletal disorders, but its intra-carpal injection has not been studied. Therefore, we conducted a controlled trial to compare ketorolac with triamcinolone in CTS. Methods: : In this blinded, randomized, controlled trial, patients with mild to moderate CTS were randomly allocated to two treatment groups to receive either a local injection of 30 mg ketorolac or 40 mg triamcinolone. Patients were evaluated based on the Boston Carpal Tunnel Questionnaire, electrodiagnostic findings, patient satisfaction, and any injection site reactions. Results: : Finally 43 patients were completed the study according to the protocol. Both groups showed significant improvement in the visual analog scale (VAS) and Boston Questionnaire Symptom Severity Scale (BQ-SS), Boston Questionnaire Functional Status Scale (BQ-FS), and electrodiagnostic scores at 3 months were compared with the baseline (P < 0.001). Comparison of the groups showed significant differences with respect to VAS, BQ-FS, and BQ-SS, with the observed improvement being significantly higher in the triamcinolone group. There was no difference between the two groups regarding electrodiagnostic results, patient satisfaction, and injection complications. Conclusions: : This study shows that injection of triamcinolone or ketorolac in patients with mild to moderate CTS resulted in improvement of pain, function, and electrodiagnostic findings; it also revealed that triamcinolone was superior to ketorolac in providing better analgesic effect and resulted in greater improvement in symptom severity and function.