WebMD Medical News
Louise Chang, MD
Nov. 8, 2007 (Boston) -- People with carpal tunnel syndrome may be
better off undergoing surgery early as opposed to receiving injections of
steroids to reduce their inflammation and pain, because steroids may not be as
effective in the long term.
In the new study, after an average follow-up of 5.9 years, 42% of
participants who received injections of corticosteroids to treat their carpal
tunnel syndrome needed additional treatment, compared with 12% percent of
people who underwent surgery.
Both treatments were equally effective after one year, but these differences
became apparent over long-term follow-up.
The new research was presented at the American College of Rheumatology's
annual meeting in Boston.
"Although almost half of the patients initially injected do not need any
more treatment in the long term, a little more than half will," conclude the
researchers, who were led by Domingo Ly-Pen, MD, PhD, a family physician at
"Gandhi" Health Center in Madrid. "Therefore, surgery appears to be more
effective than injections in the long term."
The carpal tunnel is a small area inside the wrist through which the median
nerve and tendons pass. Carpal tunnel syndrome occurs when the median nerve
becomes compressed within the carpal tunnel, causing numbness, tingling, and
pain in the fingers and hand that can radiate into the forearm.
The first line of treatment typically includes rest, ice, and placing the
wrist in a splint to minimize or prevent pressure on the nerve. Typically,
anti-inflammatory drugs are recommended, and steroid injections can be used for
treatment. If these measures fail, surgery is an option. During surgery, the
surgeon will open the carpal tunnel and cut the ligament that forms the top of
the carpal tunnel, relieving pressure.
"The use of corticosteroid injections is not very successful," says Eric
Matteson, MD, a professor of medicine at the Mayo Clinic in Rochester, Minn.
"It doesn't help very much, and many of the patients who get these injections
will go on to have surgery," he tells WebMD.
"The usual practice is the doctor will say, 'OK, you have carpal tunnel
syndrome, let's try a steroid shot, and if that doesn't work we can think about
surgery,'" he says. By contrast, the new study says "maybe we should think
about doing surgery in the first place."
SOURCES: 2007 annual meeting of the American College of Rheumatology,
Boston, Nov. 7-11, 2007. Domingo Ly-Pen, MD, PhD, "Gandhi" Health Center,
Madrid, Spain. Eric Matteson, MD, professor of medicine, Mayo Clinic,
Rochester, Minn. WebMD Medical Reference: "Arthritis: Carpal Tunnel
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