Steroid Injections for Carpal Tunnel Syndrome? One-Third of Patients Get Long-Term Relief, Study Finds
About one-third of patients treated with steroid injections for carpal tunnel syndrome don't need any further treatment through several years' follow-up, according to a study in the August issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
"Our study indicates that there is a therapeutic role for corticosteroid injections in the treatment of CTS," said lead author Stefanie Evers, MD, of the Mayo Clinic, Rochester, Minn. "However, more research will be needed to identify groups of patients who are more versus less likely to gain lasting benefit from steroid injections."
Long-Term Benefit of Steroid Injection for Some CTS Patients
Using a Rochester-area health database, the researchers identified 595 patients who underwent steroid injection for CTS between 2001 and 2010. In 179 patients, both hands were injected, for a total of 774 treated hands. Follow-up data from one to 12 years, with a median 7.4 years, were analyzed to determine how many patients went on to require surgery or other treatments.
The patients' mean age was 50.6 years and about 70 percent were women. On nerve function studies, most patients had mild or moderate CTS. About nine percent had diabetes and five percent had rheumatoid arthritis.
During follow-up, further treatment was required in 68 percent of treated hands; surgery was eventually performed in 63 percent of hands. The results were similar in 131 patients (159 hands) undergoing a second steroid injection. The remaining 32 percent of hands underwent no further treatment for CTS, suggesting long-term benefits from steroid injection.
Hands receiving a higher volume of fluid injected were more likely to have good long-term outcomes. The concentration of steroid injected was not a significant factor. Patients with rheumatoid arthritis were also more likely to have a good response, possibly because steroid injection reduced the inflammation associated with this disease.
Patients with CTS have compression of the median nerve in the wrist, causing hand numbness, pain and disability. Most treatment guidelines suggest trying steroid injection of the wrist before considering surgery. Several studies have shown that steroid injections provide at least short-term relief of CTS symptoms.
However, there is little evidence on the long-term benefits of steroid injection. This information could have an important effect on decisions about treatment for CTS. If groups of patients likely to benefit can be identified, steroid injection could avoid unnecessary surgery and reduce health care costs. For other groups unlikely to have long-term benefits, surgery might be a better option.
The new results suggest that about one-third of patients with CTS need no further treatment through several years after steroid injection.
"With a low cost and low risk of complications, steroid injection appears to be an excellent form of initial treatment in some CTS patients," Dr. Evers said.
The study suggests two factors, injection volume and rheumatoid arthritis, associated with a better response to steroid injection but the limitations of the database study make it difficult to draw firm conclusions about the long-term benefits of steroid injection and predictive factors.
Dr. Evers said, "Further research is necessary to identify those patients who will benefit in the long term from a corticosteroid injection, in order to provide more individualized treatment for patients with CTS."
Click here to read "Corticosteroid Injections for Carpal Tunnel Syndrome: Long-Term Follow-Up in a Population-Based Cohort"
Article: "Corticosteroid Injections for Carpal Tunnel Syndrome: Long-Term Follow-Up in a Population-Based Cohort" (doi: 10.1097/PRS.0000000000003511)
About Plastic and Reconstructive Surgery
For more than 70 years, Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, and cosmetic surgery, as well as news on medico-legal issues.
The American Society of Plastic Surgeons (ASPS) is the world's largest organization of board-certified plastic surgeons. Representing more than 8,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 93 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery.
About Wolters Kluwer
Wolters Kluwer is a global leader in professional information services. Professionals in the areas of legal, business, tax, accounting, finance, audit, risk, compliance and healthcare rely on Wolters Kluwer's market leading information-enabled tools and software solutions to manage their business efficiently, deliver results to their clients, and succeed in an ever more dynamic world.
Wolters Kluwer reported 2015 annual revenues of €4.2 billion. The group serves customers in over 180 countries, and employs over 19,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands. Wolters Kluwer shares are listed on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Wolters Kluwer has a sponsored Level 1 American Depositary Receipt program. The ADRs are traded on the over-the-counter market in the U.S. (WTKWY).
Wolters Kluwer Health is a leading global provider of information and point of care solutions for the healthcare industry. For more information about our products and organization, visit www.wolterskluwer.com, follow @WKHealth or @Wolters_Kluwer on Twitter, like us on Facebook, follow us on LinkedIn, or follow WoltersKluwerComms on YouTube.