Long-term outcome of local steroid injections versus surgery in carpal tunnel syndrome: observational extension of a randomized clinical trial

Review written by Dr Ian Gatt info

Key Points

  1. This is the first study comparing corticosteroid injection (CSI) versus surgery for a carpal tunnel syndrome (CTS) patient in the long term (i.e. > 6 years).
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BACKGROUND & OBJECTIVE

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy (1,2). The most frequent symptoms are pain and/or paraesthesia in the hand and wrist. CTS diagnosis is usually suspected when a patient has pain, tingling, or paraesthesia, affecting the fingers in the distribution of the median nerve (the thumb, index finger, middle finger, and radial half of the ring finger) (2). Nonoperative treatments are usually preferred for early or mild disease (2). When these conservative treatments are unsuccessful, decompressive surgery usually provides good relief from pain and high levels of satisfaction (2).

Local corticosteroid injection (CSI) for CTS has been observed to be more effective than surgery after a 3-month follow-up (3), with no difference observed between both forms of interventions at six and 12 months (4). In a two year follow up by the same authors, using the same population, surgery was observed to be marginally superior to a CSI (5). The purpose of this current study was to compare the long-term effectiveness of surgical treatment versus local CSI with CTS patients.

Carpal tunnel syndrome is the most common entrapment neuropathy.
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At long-term follow up, approximately 42% of the injection group had therapeutic failure compared to only about 11.6% of the surgery group, showing surgery had a higher success rate.

METHODS

  • This randomized study followed CTS patients at a mean of 6.3 years (median = 5.9 years, and SD ±2.3), managed with either surgical treatment or CSI, with results published previously for the same population for up to 2 years (3-5).
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