When considering long-term benefits, surgery may be a better treatment option than local injections of corticosteroids when treating carpal tunnel syndrome, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Boston, Mass.
Carpal tunnel syndrome is a common nerve disorder caused by compression of the median nerve as it passes through the carpal tunnel. The carpal tunnel is located at the wrist on the palm side of the hand, where eight small wrist bones (carpal bones) form a tunnel, giving rise to the name carpal tunnel. When the median nerve is compressed (squeezed by swollen tissues, for example), this can slow or block nerve impulses, resulting in symptoms ranging from mild occasional numbness to hand weakness, loss of feeling and even loss of hand function.
Researchers assessed the long-term outcomes of both surgery and corticosteroid injections in an observational extension of patients who were originally enrolled in an open, randomized clinical trial comparing injection to surgery.
After the clinical trial, participants received the usual medical treatment for CTS, according to their doctors' opinions. Researchers noted whether participants needed any follow-up treatment on the affected wrists.
At an average follow-up of 5.9 years, 41.8 percent of participants who received corticosteroid injections needed additional treatment, while only 11.6 percent of participants who underwent surgery needed additional treatment.
The researchers conclude that in long term follow-up, of seven years, decompression surgery is more effective than local injection with corticosteroids in naive CTS.
"Local corticosteroid injections and decompression surgery are both equally effective in the treatment of naive carpal tunnel syndrome in the 1 year follow-up," said Domingo Ly-Pen, MD, PhD; family physician; "Gandhi" Health Center, IMSALUD, 4th Area, Madrid, Spain; and lead investigator in the study.
"Although almost half of the patients initially injected do not need any more treatment in the long-term, a little more than half will. Therefore, surgery appears to be more effective than injections in the long-term."