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Medicine Today: Steroid injections for carpal tunnel syndrome

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For anyone who works with their hands, carpal tunnel syndrome can be a common problem. A new study in the Annals of Internal Medicine shows that although conservative management may be beneficial initially, long term symptoms often require surgery.

Carpal tunnel syndrome presents people with numbness, tingling, or pain in the hand, primarily in the thumb, index finger, or middle finger. It is caused by compression of a nerve that travels through a narrow space in the wrist (the “tunnel” in carpal tunnel syndrome).

Symptoms are usually worse at night or with repetitive wrist movements, for instance after typing.

The main treatments balance conservative management like wrist braces with surgery to actively decompress the nerve. Steroid injections are another type of conservative treatment, although their use has been controversial due to limited evidence supporting their benefit.

In this new study, Dr. Isam Atroshi, an associate professor of orthopedics at Lund University in Sweden, and colleagues, analyzed the relationship between steroid injections and carpal tunnel symptoms. They selected patients who failed treatment with a wrist brace and randomly assigned them to receive a steroid injection or a placebo injection.

Ten weeks after the injection, patients who received steroids had less symptoms compared to the placebo group. After one year, those who received steroids were less likely to need carpal tunnel surgery. However, the overall rates of surgery remained high in both the steroid (over 70 percent) and non-steroid groups (over 90 percent).

Atoshi’s study makes an important contribution to the treatment of carpal tunnel syndrome. It supports the use of steroid injections if symptoms do not improve with a wrist brace. However, it also shows that most patients are not cured by steroid injections.

The take away message is that if carpal tunnel symptoms don’t resolve with a wrist brace, steroid injections are a reasonable next step and can provide short-term benefit. They can help avoid surgery in a minority of patients, but the majority of patients will still likely need surgery for adequate long-term relief.


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