New research suggests that steroid injections may be just as effective as surgery for long-term relief from carpal tunnel syndrome (CTS) and may be even more effective than surgery for short-term relief from CTS.
The study, published in the February 2005 issue of Arthritis and Rheumatism, followed 163 wrists belonging to over 100 patients who had experienced CTS symptoms for at least three months, particularly extreme nighttime tingling and burning in their hands and fingers sufficient to disrupt sleep. Eighty of the wrists received the standard surgical procedure of decompression of the median nerve; the remaining 83 wrists received local steroid injections. After 14 days, 69 of the previously injected wrists were injected again. Duration, severity and patient age were similar among both the surgery and steroid injection groups.
Symptoms of both groups were evaluated at three months, six months and 12 months for improvement. Ninety-four percent of the injected wrists showed significant (20 percent or better) improvement at three-months, measured by a visual analog scale; only 75 percent of the surgery group showed the same level of improvement at three months. At six months, just under 86 percent of the injection group showed significant improvement while 76.3 percent of the surgery group showed a similar level of improvement. At 12 months, 69.9 percent of the injection group showed significant improvement compared to 70 percent of the surgery group.
“This is the first randomized controlled clinical trial comparing the two most common therapies for CTS. 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,” reported Dr. Domingo Ly-Pen, one of the study’s authors.
Both surgery and steroid injections are considered medical management for CTS. In situations where CTS is aggravated by work, ergonomics principals can also be applied to the workstations to help minimize the discomfort of CTS patients and to also help reduce the risk of developing CTS.
Sources: Science Daily (www.sciencedaily.com); Ergonomics TodayTM