Dutch injection versus surgery trial in patients with carpal tunnel syndrome (DISTRICTS): protocol of a randomised controlled trial comparing two treatment strategies

Wijnand A C Palmbergen, Rob M A de Bie, Tim W H Alleman, Esther Verstraete, Korne Jellema, Wim I M Verhagen, Geert J F Brekelmans, Godard C W de Ruiter, Diederik van de Beek, Corianne A J M de Borgie, Rob de Haan, Roy Beekman, Camiel Verhamme

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)


INTRODUCTION: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy. The optimal treatment strategy is still unknown. The objective of the Dutch Injection versus Surgery TRIal in patients with CTS (DISTRICTS) is to investigate if initial surgery of CTS results in a better clinical outcome and is more cost-effective when compared with initial treatment with corticosteroid injection. METHODS AND ANALYSIS: The DISTRICTS is an ongoing multicenter, open-label randomised controlled trial. Participants with CTS are randomised to treatment with surgery or with a corticosteroid injection. If needed, any additional treatments after this first treatment are allowed and these are not dictated by the study protocol. The primary outcome is the difference between the groups in the proportion of participants recovered at 18 months. Recovery is defined as having no or mild symptoms as measured with the 6-item carpal tunnel symptoms scale. Secondary outcome measurements are among others: time to recovery, hand function, patient satisfaction, quality of life, additional treatments, adverse events, and use of care and health-related costs. ETHICS AND DISSEMINATION: The study was approved by the Medical Ethical Committee of the Amsterdam University Medical Centers (study number 2017-171). Study results will be disseminated in peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER: ISRCTN Registry: 13164336.
Original languageEnglish
Article numbere057641
Pages (from-to)e057641
JournalBMJ Open
Issue number4
Publication statusPublished - 6 Apr 2022


  • Adult neurology
  • Neuromuscular disease

Cite this