Steroid shots as good as surgery for carpal tunnel

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New research suggests that a couple injections of corticosteroids may work as well as surgery for many cases of carpal tunnel syndrome—at least in the first year after treatment.

Carpal tunnel syndrome is a disorder of the wrist and hand caused by pressure on the median nerve, which runs through a narrow passageway in the wrist—the carpal tunnel. Symptoms include pain, numbness and weakness in the hand, fingers and wrist.

There is no universally accepted first-line treatment, but the options include wrist splints, anti-inflammatory painkillers, injections of inflammation-fighting corticosteroids and surgery in which the ligaments surrounding the median nerve are cut to relieve pressure on the nerve.
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In the new study, researchers in Spain found that among 101 patients with carpal tunnel syndrome, those who received steroid injections into the wrist fared about as well over the next year as those who had surgery. The steroid therapy actually showed more immediate benefits, with more steroid patients than surgery patients reporting improved symptoms 3 months after treatment.

The findings are published in the February issue of the journal Arthritis & Rheumatism.

The study excluded carpal tunnel patients who had weakness and wasting in the muscles of the hand. Study co-author Dr. Jose-Luis Andreu told AMN Health he and his colleagues believe such patients need surgery.

“But in less severe cases, local injection is an excellent option—cheaper and more feasible,” said Andreu, a rheumatologist at the Hospital Puerta de Hierro in Madrid.

The study included mostly middle-aged female patients, many of whom had carpal tunnel syndrome in both wrists. They were randomly assigned to receive either surgery or steroid injections into the wrist—two injections in most cases.

After 3 months, 94 percent of the treated wrists in the steroid group showed at least a 20-percent improvement in nighttime symptoms of burning and tingling in the hands and fingers. That compared with 75 percent of the surgically treated wrists.

One year later, 70 percent of the steroid-treated wrists were still showing such an improvement, while the number in the surgery group remained at 75 percent. Throughout the study, steroid and surgery patients showed similar improvements in daytime pain and in hand and wrist function—though in this latter measure, surgery patients were doing better at the one-year mark.

According to Andreu, it’s not yet clear how long the benefits of steroid injections can last in carpal tunnel syndrome. He and his colleagues are following the patients for a second year to see how well the effects of both treatments hold up.

SOURCE: Arthritis & Rheumatism, February 2005.

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