Are Steroid Injections For Carpal Tunnel Syndrome A Cover Or A Cure?
read time: 4 minutes
Let’s check back in with Laurie. She’s now five weeks into her misery of waking two or three times a night with a burning numbness in her hand. She’s short with her family, lives in a fog, and the mistakes at work keep piling up.
She’s venting to her friend Donna at coffee (her third of the morning) when Donna chirps, ‘Oh, I had the same thing happen to me a month ago. My doc just gave me a steroid injection and I’m back to normal!’ A wave of relief (and a touch of envy) washes over Laurie as she picks up the phone to call her doctor’s urgent line…
You may recall that carpal tunnel syndrome is an extremely common and painful nerve compression syndrome of the hand in which the median nerve gets pinched at the wrist as it passes through an anatomic space known as the carpal tunnel.
Note: This post is part of a family of previous Rules of Thumb posts about carpal tunnel syndrome. If you’d like to catch up on those, search for “carpal tunnel” in the Rules of Thumb archive.
Mainstays of carpal tunnel syndrome treatment include:
Nighttime bracing (we all curl up our wrists at night → pinches the median nerve)
A steroid injection into the carpal tunnel
Surgery to decompress the nerve
Unfortunately, less invasive treatments like physical therapy or oral medications have not shown any significant benefit in treating this condition.
But do steroid injections really work?
However, there’s one theoretical problem regarding the use of a steroid injection for carpal tunnel syndrome.
Most of the time, carpal tunnel syndrome is not a result of inflammation (rheumatoid arthritis patients excepted.)
So is squirting a large volume of anti-inflammatory medication (ie, steroid) into an already-too-small space really an effective treatment?
Before we look at the data, a quick side note on the confusing language of steroids.
I often bring up steroid injections as a treatment option for various ailments in my clinic. And I am then frequently asked by my patients, ‘But what about cortisone? Is that an option?”
It’s the same thing.
Cortisone is one type of steroid. Other steroids you may hear of include dexamethasone, betamethasone, triamcinolone, etc. While there are subtle differences, for this discussion we will lump them all together as ‘steroid injections.’
Ok, back to the data. As a whole, I would rate the research we have available on this subject to be of average quality. What is lacking is a well-done study that keeps up with patients for longer than 12 months after their injection.
This means science hasn’t answered the question of ‘Can a steroid injection cure carpal tunnel syndrome?’ All we can answer from 12-month data is the question ‘Does a steroid injection make my carpal tunnel symptoms feel better for a while?’
And the answer in the short term seems to be yes. Studies following the results of carpal tunnel injections (graph above) show us that at:
6 weeks after injection, 79% of patients had sustained symptom relief.
3 months after injection, the rate remained fairly high at 70% symptom-free patients.
At 6 months, the first significant drop-off appears, as the rate fell to 53%.
By 12 months, the rate dropped to about 30%. In one study, only 33% of patients had not progressed to surgical release of their carpal tunnel. In another study, 31% of patients still had resolution of their symptoms from their single injection.
So if you’ve tried nighttime bracing for a few weeks without relief of your miserable carpal tunnel symptoms, yet it’s not the right time in your life to recover from surgery, a steroid injection may not be a bad idea.
What is clear from our available data though is that the general trend of carpal tunnel syndrome is often a slow worsening of the pinched nerve over time.
Which means that a strategy of ‘Hey, let’s just repeat steroid injections when the effects wear off’ can lead to a dangerous progression and possibly permanent level of nerve damage. When that happens, not even surgery can fix the numbness or weakness you feel in your hand.
😔
Takeaways:
Carpal tunnel steroid injections provide reliable short-term relief in most people for between 3 and 6 months
Carpal tunnel injections are likely not a repeatable long-term strategy to use to cure carpal tunnel syndrome
As with all things in life, we must evaluate what tools we have at our disposal and the expected efficacy of each tool. And then we choose based on the risk/benefit calculation.
Hopefully this piece arms you with the data you need to help you make that calculation (remember, you’re calculating for you, not your neighbor, your friend, or your mom) a little easier.
