Intracarpal steroid injection is safe and effective for short‐term management of carpal tunnel syndrome

Abstract

A double-blinded placebo-controlled trial was performed to evaluate the use of steroid injections beneath the transverse carpal ligament in the treatment of carpal tunnel syndrome (CTS) refractory to nonsurgical therapy. Forty-three patients received 6 mg betamethasone and lidocaine and 38 patients received 1 ml saline placebo and lidocaine. The primary outcome measure was satisfaction with symptom relief. Thirty patients (70%) in the steroid-treated group were satisfied or highly satisfied compared with 13 (34%) of placebo-treated patients (P < 0.001). Patients receiving steroids also showed significant improvement in median nerve conduction parameters and scores on validated symptom/function questionnaires. Forty-six patients were treated with serial injections for recurrent CTS symptoms. After 18 months, 17 patients reported adequate symptom relief with steroid injection, and 18 patients with unsatisfactory symptom relief were referred for carpal tunnel release surgery. We conclude that although steroid injections are safe and effective for temporary relief of CTS, most patients will eventually require surgery for long-term control of their symptoms.

Prospective Comparison of the Six-Item Carpal Tunnel Symptoms Scale and Portable Nerve Conduction Testing in Measuring the Outcomes of Treatment of Carpal Tunnel Syndrome with Steroid Injection

“…Armstrong et al compared steroid injection to placebo injection for the treatment of carpal tunnel syndrome in 81 patients [1]. Similar to our findings, those patients who received the steroid injection experienced statistically significant improvement in their symptoms as measured by the Carpal Tunnel Study Functional Status and Symptom Severity Questionnaire as well as median sensory distal latency when compared to the placebo group at 2 weeks.…”

“…Few studies have combined outcome measures and the results of NCS with treatment with steroids [1,12,22,24].…”

Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study

“…107 Evidence from a second Cochrane systematic review 108 indicated that local corticosteroid injections provided greater improvement in clinical symptoms after 1 month than placebo injections. Two RCTs 109,110 (141 participants) at low risk of bias demonstrated a significant increase [risk ratio (RR) = 2.58; 95% CI 1.72 to 3.87] in the incidence of short-term (2-4 weeks) clinical improvements after steroid injection. These two studies recruited patients whose symptoms were refractory to prolonged periods of conservative care (> 3 months 110 and 6 weeks of hand splinting 109 ).…”

“…Two RCTs 109,110 (141 participants) at low risk of bias demonstrated a significant increase [risk ratio (RR) = 2.58; 95% CI 1.72 to 3.87] in the incidence of short-term (2-4 weeks) clinical improvements after steroid injection. These two studies recruited patients whose symptoms were refractory to prolonged periods of conservative care (> 3 months 110 and 6 weeks of hand splinting 109 ). In both trials symptomatic improvement was achieved in ≥ 70% of patients who had steroid injection, but in only 20-34% of patients in the placebo arm.…”

Conservative therapeutic management of carpal tunnel syndrome

“…In seven studies of adequate methodology 6,7,8,9,10,11,12,13 , Piazzini et al 11 concluded that corticosteroid injection in the carpal tunnel can be considered as an effective treatment. However, no significant clinical benefit was found for corticosteroid injections compared with other treatments, including splint immobilization 14,15 .…”