UK multicentre RCT of steroid injection v surgery in moderate CTS

Dear Dr Bland,

I am an Orthopaedic Hand Surgeon in Gloucester and for the last year have been developing an RCT of steroid injection versus surgery for moderate CTS. I agree with the Cochrane review that this has not been studied well enough and that we have not conclusively answered this. NICE guidelines do not specify what non-operative management should consist of for moderate CTS and CCG's policies for referral vary widely across the country, most probably due to the lack of evidence here.

The development of the proposal has been sponsored by the BSSH (£50,000) and under the auspices of the Oxford Clinical Trials Unit we are applying for NIHR funding for the trial. We plan a feasibility study this year as part of the proposal. We are also planning a full health economic analysis.

I have of course come across your website in my reading and found it very helpful. I would very much appreciate it if I could email you our you our draft funding proposal and would greatly value your comments. In particular, do you agree that there is a research question worth asking here, despite the extensive literature?

I would like to reassure you that I am not at all biased in favour surgery, as you may reasonably assume, but just wish to be able to advise my patients better. It may well be that we should inject all patients with moderate CTS first, as many of my GP colleagues tell me. However, the guidelines do not currently advise this.

If you are able to help us with this project (and possibly even take part in the trial, if we are successful in our application) I would be very grateful. My email address is wtmmason [at] me [dot] com.

With kind regards,

Will Mason