steriod management for carpal tunnel

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From Muscle Nerve. 2004 Jan; 29(1): 82-8.

Intracarpal steroid injection is safe and effective for short-term

management of carpal tunnel syndrome.

Armstrong T, Devor W, Borschel L, Contreras R.

Department of Neurology, Kaiser Permanente, 4405 Vandever Avenue, San

Diego, California 92120, USA.

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.