Comparison of treatment strategies for carpal tunnel syndrome

project manager

phd fellow

About the project

Carpal tunnel syndrome causes numbness and pain in the hand and forearm. It is the most common non-traumatic hand disorder in Norway, and is a major cause of work absence and disability. Currently, about 4% of the population has carpal tunnel syndrome. In Norway, about 7500 surgeries were performed due to this in 2017, which gives an adjusted incidence of 140 surgical interventions per 100 000 inhabitants. It is well documented that patients with severe carpal tunnel syndrome should be treated surgically. However, treatment of the patient group with mild to moderate symptoms is controversial, and this is one of the conditions where health authorities have encouraged increased use of non-surgical treatment. Currently, there is a limited evidence base in this area. In Norway today, both treatment strategies are in use, but the vast majority of patients undergo surgery without having tried cortisone injections beforehand.

NOR-CACTUS is a two-year multicenter randomized controlled clinical trial. The main objective of the study is to investigate whether a treatment strategy where the patient receives injection therapy, followed by surgery in case of suboptimal effect, gives non-inferior results to a treatment strategy where the patient undergoes surgery directly.

Who can participate?

Patients with carpal tunnel syndrome.

Recruitment in the study is ongoing.

Project arrangement

In one arm of the study, participants will first receive an ultrasound-guided cortisone injection and then be monitored for the need for a second cortisone injection or surgery. In the second arm of the study, participants will undergo surgery directly and then be followed up. In addition to clinical examination, study participants will be examined with ultrasound, patient-reported outcome measures and neurography. We will assess efficacy both at the individual level and from a socio-economic perspective. We will assess the efficacy and safety of the treatment strategies, prognostic factors and societal consequences (e.g. sick leave, costs related to treatment).


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