Steroids May Beat Surgery for Carpal Tunnel

Steroid Injections Provide Better Short-Term Relief of Pain From Carpal Tunnel Syndrome

Medically Reviewed by Brunilda Nazario, MD on February 03, 2005
From the WebMD Archives

Feb. 3, 2005 - Steroid injections may be more effective than surgery for short-term relief of painful carpal tunnel syndrome symptoms, according to a new study.

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 after treatment:

  • 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 group.
  • 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 surgery group.

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 term."

Show Sources

SOURCES: Ly-Pen, D. Arthritis & Rheumatism, February 2005; vol 52: pp 612-619. News release, John Wiley & Sons, Inc.

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