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Steroids for Carpal Tunnel Questioned

Study Supports Role for Early Surgery to Treat Carpal Tunnel Syndrome
By
WebMD Health News
Reviewed by Louise Chang, MD

Nov. 8, 2007 (Boston) -- People with carpal tunnel syndrome may be better off undergoing surgery early as opposed to receiving injections of steroids to reduce their inflammation and pain, because steroids may not be as effective in the long term.

In the new study, after an average follow-up of 5.9 years, 42% of participants who received injections of corticosteroids to treat their carpal tunnel syndrome needed additional treatment, compared with 12% percent of people who underwent surgery.

Both treatments were equally effective after one year, but these differences became apparent over long-term follow-up.

The new research was presented at the American College of Rheumatology's annual meeting in Boston.

"Although almost half of the patients initially injected do not need any more treatment in the long term, a little more than half will," conclude the researchers, who were led by Domingo Ly-Pen, MD, PhD, a family physician at "Gandhi" Health Center in Madrid. "Therefore, surgery appears to be more effective than injections in the long term."

The carpal tunnel is a small area inside the wrist through which the median nerve and tendons pass. Carpal tunnel syndrome occurs when the median nerve becomes compressed within the carpal tunnel, causing numbness, tingling, and pain in the fingers and hand that can radiate into the forearm.

The first line of treatment typically includes rest, ice, and placing the wrist in a splint to minimize or prevent pressure on the nerve. Typically, anti-inflammatory drugs are recommended, and steroid injections can be used for treatment. If these measures fail, surgery is an option. During surgery, the surgeon will open the carpal tunnel and cut the ligament that forms the top of the carpal tunnel, relieving pressure.

Steroid Shots 'Not Successful'

"The use of corticosteroid injections is not very successful," says Eric Matteson, MD, a professor of medicine at the Mayo Clinic in Rochester, Minn. "It doesn't help very much, and many of the patients who get these injections will go on to have surgery," he tells WebMD.

"The usual practice is the doctor will say, 'OK, you have carpal tunnel syndrome, let's try a steroid shot, and if that doesn't work we can think about surgery,'" he says. By contrast, the new study says "maybe we should think about doing surgery in the first place."

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