Steroids May Beat Surgery for Carpal Tunnel
Steroid Injections Provide Better Short-Term Relief of Pain From Carpal Tunnel Syndrome
Feb. 3, 2005 - Steroid injections may be more effective than surgery for
short-term relief of painful carpal tunnel syndrome symptoms, according to a
Researchers compared the effectiveness of steroid injections vs. surgery in
relieving the symptoms of carpal tunnel syndrome over the course of a year and
found that the shots were just as effective as surgery at long-term relief of
pain and may actually be more effective in the short-term.
Although the pain, tingling, and weakness of the thumb, index , and middle
fingers of the hand caused by carpal tunnel syndrome are common problems among
computer workers and others who perform repetitive motions, researchers say
there is no preferred treatment for the disorder.
The researchers say carpal tunnel syndrome is one of the most commonly
reported occupational illnesses.
The condition occurs when the median nerve, which runs from the forearm to
the base of the palm, becomes compressed by inflammation within a band of
tissue in the wrist. Typically the symptoms are worse at night.
Mild cases may be treated with anti-inflammatory medications, local
injections of steroids at the source of pain, or wearing splints on the hand
and wrist to relieve pressure on the median nerve. More severe cases are often
treated with surgery to decompress the nerve, since this condition can lead to
partial loss of function of the thumb and permanent loss of sensation.
But the researchers say insufficient studies exist about the optimal
treatment method for carpal tunnel syndrome.
Surgery vs. Shots for Carpal Tunnel
In the study, researchers looked at the effects of surgical treatment vs.
steroid injections in 163 wrists belonging to 101 patients (93 women and 8 men)
with newly onset carpal tunnel syndrome. All of the patients had carpal tunnel
symptoms, such as nightly attacks of extreme tingling and burning in the hand
and fingers that disrupted their sleep for at least three months.
Eighty of the wrists were treated with the standard surgical decompression
procedure, and the remaining 83 were treated with local steroid injections.
Fourteen days after treatment, 69 of the wrists that were treated with steroid
injections received a second injection.
Researchers compared carpal tunnel syndrome symptoms in both groups and
their overall perceived functional impairment at three, six, and 12 months
- At three months, 94% of the wrists treated with steroid injections vs. 75%
of the surgically treated wrists experienced an improvement of at least 20% in
their nighttime symptoms.
- At six months, 86% of the injection group had achieved a 20% or better
improvement in nighttime pain symptoms compared with 76% of the surgery
- One year after treatment, 70% of the wrists in the injection group had a
20% or more improvement in the nocturnal symptoms compared with 70% of the
At the end of the follow-up period, self-assessed functional impairment was
similar in both groups.
"This is the first randomized, controlled clinical trial comparing the
two most common therapies for CTS," writes researcher Domingo Ly-Pen, MD,
PhD, of the Primary Care Unit Gandhi in Madrid, Spain, and colleagues. "Our
findings suggest that both local steroid injections and surgical decompression
are highly effective in alleviating the symptoms of primary CTS at 12 months of
follow-up. Nevertheless, local injection seems superior to surgery in the short