NOR-CACTUS
Comparison of treatment strategies for carpal tunnel syndrome
Project managers
Postdoc
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 significant cause of work absence and disability. Currently, approximately 4% of the population has carpal tunnel syndrome. In Norway, approximately 7,500 patients underwent surgery for this condition 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 knowledge base for 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 primary objective of the study is to investigate whether a treatment strategy in which the patient receives injection therapy, followed by surgery in the event of suboptimal effect, provides non-inferior results to a treatment strategy in which the patient undergoes direct surgery.
WHO CAN JOIN?
Patients with carpal tunnel syndrome.
Recruitment into the study is ongoing.
WHAT DOES THE STUDY INVOLVE?
In one arm of the study, study participants will first receive ultrasound-guided cortisone injections and then be monitored for the need for another cortisone injection or surgery. In the other arm of the study, participants will undergo surgery directly and then be monitored further. In addition to clinical examination, study participants will be examined with ultrasound, patient-reported outcome measures and neurography. We will assess the effect both at the individual level and from a socio-economic perspective. We will assess the effect and safety of the treatment strategies, prognostic factors and societal consequences (e.g. sick leave, costs related to treatment).