Steroid Shots a Temporary Fix for Carpal Tunnel?
Three-quarters of patients still had to have surgery a year later
By Dennis Thompson
TUESDAY, Sept. 3 (HealthDay News) -- Steroid shots can temporarily relieve the painful symptoms of carpal tunnel syndrome, but three-quarters of patients who are initially helped by these injections will eventually require surgery, new Swedish research says.
About 5 percent of Americans suffer from carpal tunnel syndrome, which occurs due to pressure on a key nerve that runs from the forearm into the palm of the hand. It is a repetitive-motion injury that tends to affect people performing assembly line or data entry work.
The median nerve is housed within the tight confines of the carpal tunnel, a narrow corridor of ligament and bones at the base of the hand. Tendons located in the carpal tunnel can swell and squeeze the median nerve if they become irritated and inflamed. Sufferers feel pain, tingling and numbness in the affected hand and wrist, with pain sometimes shooting up their arm.
Steroid shots frequently are used to reduce tendon swelling and ease pressure on the nerve, said Dr. David Ruch, chief of orthopedic hand service at the Duke University Medical Center and practice division director for the American Society for Surgery of the Hand. Mild cases can be treated with splints worn to keep the wrists straight until swelling inside the carpal tunnel goes down.
However, surgery to open up the carpal tunnel and relieve pressure on the nerve remains the most effective treatment for moderate to severe cases, so much so that carpal tunnel release is one of the most common surgical procedures in the United States, according to the U.S. National Institute of Neurological Disorders and Stroke.
The new study affirms the common perception among doctors that steroid shots serve as only a temporary fix for patients with moderate or severe cases of carpal tunnel syndrome, Ruch said.
"The long-term ability of carpal tunnel syndrome to be treated with an injection is really based upon the severity of your symptoms, how long the symptoms have been in place and how old you are," he said.
The new research, from doctors at Hassleholm Hospital in Sweden and published in the Sept. 3 issue of the journal Annals of Internal Medicine, involved 111 patients aged 18 to 70 with carpal tunnel syndrome who had no previous steroid injections. Doctors treated two-thirds of the patients with injections of methylprednisolone, a type of steroid.
Within 10 weeks, people who received steroid injections were less likely to report pain, numbness, tingling or other symptoms.
Three out of four patients who received steroids, however, needed surgery within one year.
Those most likely to benefit from steroid shots are people under 30 with mild symptoms and less pressure on their median nerve. "You have a reasonable chance of having your symptoms go away and stay gone with the cortisone shot," Ruch said.