***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To compare low and high dose , and short and long acting corticosteroids in the treatment of carpal tunnel syndrome . METHODS A r and omised , controlled , single blind trial with electromyographic and subjective outcome measures . RESULTS 25 mg hydrocortisone is as effective as higher doses or long acting triamcinolone at a six week and six month follow up . CONCLUSION As low dose steroid is as effective , and potentially less toxic , this should be the recommended dose for injection of carpal tunnel syndrome The purpose of this study was to investigate the long-term prognosis of patients with carpal tunnel syndrome ( CTS ) . We prospect ively followed-up patients with CTS for 80 weeks . Thirty cases had been treated with a single injection of methylprednisolone acetate and another 30 with a 10-day course of prednisolone . At the end of the follow-up period , there were no significant differences in symptoms as measured by global symptom score and in the proportion of patients who progressed to decompressive surgery . Few patients who were not operated on ( 11.4 % ) remain asymptomatic Objective : To study the demographic characteristics of patients with carpal tunnel syndrome and changes in incidence over time . Methods : Prospect i ve collection of neurophysiological and clinical data on all patients presenting to the subregional department of clinical neurophysiology in Canterbury , UK , from 1992 to 2001 and to the electromyography clinic in St Luke ’s Hospital , Huddersfield , UK , from 1991 to 1993 . Results : 6245 new cases of neurophysiologically confirmed carpal tunnel syndrome were identified in Canterbury and 590 in Huddersfield . The average annual incidences ( per 100 000 ) were 139.4 for women and 67.2 for men in East Kent , and 83.2 for women and 48.0 for men in Huddersfield . Corrected to the WHO European st and ard population these rates were 120.5 for women and 60.0 for men in East Kent , and 61.5 for women and 35.0 for men in Huddersfield . Between 1992 and 2001 there was an increase in the number of confirmed cases in East Kent but a decrease in their average severity . The age distributions were bimodal with a peak in the 50–54 age group and a second peak between 75 and 84 years . Over half the cases were bilateral . The disorder was consistently worse in the elderly , and more severe in men than in women in all age groups . Conclusions : The age distributions of unselected cases of carpal tunnel syndrome in both clinics differ markedly from that usually portrayed in surgical series . There was a significant increase in cases diagnosed between 1992 and 2001 in Canterbury , probably the result of increased ascertainment of milder cases . Median nerve impairment is more severe in the elderly and in men at all ages The authors compared the effectiveness of low-dose , short-term oral prednisolone vs local methylprednisolone injection in a prospect i ve , double-blinded , parallel treatment study of carpal tunnel syndrome ( CTS ) . A single injection of 15 mg methylprednisolone result ed in significant improvement in global symptom scores over a 12-week period . This study demonstrated the superiority of local steroid injection to oral steroid in the treatment of CTS Çeliker R , Arslan Ş , İnanıcı F : Corticosteroid injection vs. nonsteroidal antiinflammatory drug and splinting in carpal tunnel syndrome . Am J Phys Med Rehabil 2002;81:182–186 . Objective To compare the efficacy of local corticosteroid injection to a nonsteroidal antiinflammatory drug and splinting for the treatment of carpal tunnel syndrome . Design This study was a prospect i ve , unblinded , r and omized clinical trial with an 8-wk follow-up . Thirty-three h and s of 23 patients were r and omly treated with acemetacine and splinting ( group A ) or with corticosteroid injection ( group B ) . Clinical ( symptom severity scale , visual analog scale , Tinel and Phalen tests ) and electromyographic evaluations were performed on initial visit and after 8 wk . Results Clinical and electromyographic parameters , which were similar at baseline , were improved in both groups after treatment . Improvement was also similar when both groups were compared at 8 wk . Conclusion Both splinting combined with the use of a nonsteroidal antiinflammatory drug and steroid injection into the carpal tunnel result ed in significant improvement in carpal tunnel syndrome Objective : To assess the course of untreated carpal tunnel syndrome ( CTS ) . Methods : The Italian CTS Study Group prospect ively followed up ( 10 to 15 months ) 196 untreated patients ( 274 h and s ) with idiopathic CTS with multiple measurements of CTS .  Baseline factors were used to predict the evolution of untreated CTS in multiple regression analysis . Results : Comparison of baseline and follow-up data showed a significant spontaneous improvement of patient-oriented and neurophysiologic measurements . A significant correlation between evolution and initial severity of CTS was observed .  CTS measurements improved in patients with more severe initial impairment whereas they worsened in patients with milder initial impairment . The main positive prognostic factor was short duration of symptoms . Similarly , spontaneous improvement was more frequently associated with young age . Conversely , baseline bilateral symptoms and positive Phalen predicted a poor prognosis . Conclusions : Some patients with CTS  improve spontaneously without surgical treatment CONTEXT Carpal tunnel syndrome ( CTS ) is a cause of pain , numbness , and tingling in the h and s and is an important cause of work disability . Although high prevalence rates of CTS in certain occupations have been reported , little is known about its prevalence in the general population . OBJECTIVE To estimate the prevalence of CTS in a general population . DESIGN General health mail survey sent in February 1997 , inquiring about symptoms of pain , numbness , and tingling in any part of the body , followed 2 months later by clinical examination and nerve conduction testing of responders reporting symptoms in the median nerve distribution in the h and s , as well as of a sample of those not reporting these symptoms ( controls ) . SETTING A region in southern Sweden with a population of 170000 . PARTICIPANTS A sex- and age-stratified sample of 3000 subjects ( age range , 25 - 74 years ) was r and omly selected from the general population register and sent the survey , with a response rate of 83 % ( n = 2466 ; 46 % men ) . Of the symptomatic responders , 81 % underwent clinical examination . MAIN OUTCOME MEASURES Population prevalence rates , calculated as the number of symptomatic responders diagnosed on examination as having clinical ly certain CTS and /or electrophysiological median neuropathy divided by the total number of responders . RESULTS Of the 2466 responders , 354 reported pain , numbness , and /or tingling in the median nerve distribution in the h and s ( prevalence , 14.4 % ; 95 % confidence interval [ CI ] , 13.0%-15.8 % ) . On clinical examination , 94 symptomatic subjects were diagnosed as having clinical ly certain CTS ( prevalence , 3.8 % ; 95 % CI , 3.1%-4.6 % ) . Nerve conduction testing showed median neuropathy at the carpal tunnel in 120 symptomatic subjects ( prevalence , 4.9 % ; 95 % CI , 4.1%-5.8 % ) . Sixty-six symptomatic subjects had clinical ly and electrophysiologically confirmed CTS ( prevalence , 2.7 % ; 95 % CI , 2.1%-3.4 % ) . Of 125 control subjects clinical ly examined , electrophysiological median neuropathy was found in 23 ( 18.4 % ; 95 % CI , 12.0%-26.3 % ) . CONCLUSION Symptoms of pain , numbness , and tingling in the h and s are common in the general population . Based on our data , 1 in 5 symptomatic subjects would be expected to have CTS based on clinical examination and  electrophysiologic testing Objective : To determine the incidence of carpal tunnel syndrome ( CTS ) in a general population of a restricted area in the middle part of Italy . Methods : Prospect i ve study to identify cases of CTS , newly diagnosed on the basis of clinical symptoms and delay in distal conduction velocity of the median nerve . In the 8-year period from 1991 to 1998 , cases were identified by electromyographic services in the Siena area of Local Health District No. 7 of Tuscany ( Italy ) . This area has a population of 120,000 . Results : In the 8-year period , 3,142 cases ( 79.7 % women and 20.3 % men ; mean age , 55 years ; range , 13 to 97 years ) were identified . The mean annual crude incidence was 329 cases per 100,000 person-years , and the st and ardized incidence was 276 . The sex-specific incidences were 139 for men and 506 for women . The mean annual incidence for men increased moderately but significantly during the study period , whereas that for women remained constant . The age-specific incidence for women increased gradually with age , reaching a peak between 50 and 59 years , after which it declined . In men , there was a bimodal distribution with peaks between 50 and 59 years and between 70 and 79 years . Rural and industrial areas had higher crude and age- and sex-specific incidences than did urban areas . Conclusions : The incidence in the Siena area is about threefold that reported in the Rochester area ( Minnesota ) and is similar to that of Marshfield ( Wisconsin ) . The different results with respect to US reports may depend on case inclusion criteria and occupational activities of the population at risk Background : Conservative treatment of mild to moderate carpal tunnel syndrome ( CTS ) is variable . Objective : To evaluate the effectiveness of commonly used oral medications such as diuretics , nonsteroid anti-inflammatory drugs ( NSAIDs ) , and steroids in the treatment of CTS . Methods : Prospect i ve , r and omized , double-blind and placebo-controlled study of patients with clinical symptoms and signs of CTS , confirmed by st and ard electrodiagnosis . Baseline assessment s included a st and ardized symptom question naire , rating five categories of symptoms ( pain , numbness , paresthesia , weakness/clumsiness , and nocturnal awakening ) on a scale from 0(no symptoms ) to 10 ( severe ) . The total score in each of the five categories was termed the global symptom score ( GSS ) . After baseline assessment , patients were r and omized to the following treatment arms : 1 ) 4 weeks of placebo ( N = 16 ) ; 2 ) 4 weeks of diuretic ( trichlormethiazide , 2 mg daily ; n = 16 ) ; 3 ) 4 weeks of NSAID-slow release ( SR ) ( tenoxicam-SR , mg daily ; n = 18 ) ; and 4 ) 2 weeks of prednisolone , 20 mg daily , followed by another 2-week dosage of 10 mg daily ( n = 23 ) . Results of follow-up assessment s in the second and the fourth weeks were identical to baseline scores . The changes in GSS were analyzed to determine the statistical difference . Results : No significant reduction from baseline GSS was seen at second , and fourth weeks in the placebo , NSAID-SR , and diuretic groups . However , the mean score at 4 weeks in the steroid group decreased significantly from a baseline of 27.9 ± 6.9 to 10 ± 7.4 . Conclusion : For patients with mild to moderate CTS who opt for conservative treatment , corticosteroids are of greater benefit A clinical and electrophysiological study evaluated the usefulness of local steroid therapy for carpal tunnel syndrome ( CTS ) . To evaluate the efficacy of local steroid therapy  32 patients ( 53 nerves ) were r and omly assigned to one of two groups : one ( 27 nerves ) received 15 mg methylprednisolone acetate injected locally and the other ( 26 nerves ) received the same amount of saline solution . The injections were repeated after a week . Clinical and electrophysiological findings were evaluated , double blind , at regular intervals . A clear-cut efficacy of steroid treatment was found . Only 8 % of nerves were not benefitted while a marked early improvement was observed in most of the nerves . In order to appraise the long-term effect of local steroid treatment on CTS , 53 patients ( 91 nerves ) were studied and followed up by means of clinical and electrophysiological examinations performed every 2 months for 2 years . The benefit of steroid treatment was transient . About 50 % of the nerves became worse within 6 months and 90 % within 18 months . Only a small percentage ( 8 % ) of the nerves remained improved at the 2-years follow-up . The clinical features were not useful in foretelling the duration of the improvement , which appeared to be related to the antidromic SAP latency Question : In patients with carpal tunnel syndrome ( CTS ) , what is the long-term effectiveness of oral steroids given for 2 weeks compared with 4 weeks ? Design : R and omized ( allocation concealed ) , blinded ( clinicians , patients , data collectors , and data analysts ) , placebo-controlled trial with 12-month follow-up . Setting : A hospital in Taichung , Taiwan . Pat 
    Output:
    
REVIEW ER 'S CONCLUSIONS Local corticosteroid injection for carpal tunnel syndrome provides greater clinical improvement in symptoms one month after injection compared to placebo .
Symptom relief beyond one month compared to placebo has not been demonstrated .
Local corticosteroid injection provides significantly greater clinical improvement compared to oral steroid up to three months after treatment .