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Steroid injections in carpal tunnel syndrome – how effective are they?

September 23, 2013
Research from Sweden published at the beginning of September suggests that patients with carpal tunnel syndrome who have injections of methylprednisolone into their wrist joint are less likely to need surgery. Dr Hadi Manji, Consultant Neurologist at The Physicians’ Clinic who has a special interest in peripheral nerve disorders such as carpal tunnel syndrome, reviews the study and explains more about this common condition.

What is carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) occurs when the median nerve, which supplies the hand, becomes compressed at the point where it passes through a narrow channel through the bones and tendons of the wrist. This channel is called the carpal tunnel. “CTS is more common in people who have had a wrist injury, in pregnant women (it usually resolves after the end of the pregnancy), in people who work with their hands (and experience a repetitive strain injury) and in patients with rheumatoid arthritis, diabetes and hypothyroidism,” explains Dr Manji. Symptoms include:
  • Tingling (pins and needles) and/ or numbness in the fingers (usually affecting the thumb, index and middle fingers), which is worse at night and may wake you up in the night. The symptoms may also occur when driving, holding up a newspaper or telephone for long periods.
  • A dull, ache or pain in the hand or even up the arm.
  • Wasting and weakness of some hand muscles (in severe cases)

How is carpal tunnel syndrome diagnosed?

“A neurologist will make the diagnosis by taking a history and perform an examination looking for wasting and weakness in the muscles supplied by the median nerve,” says Dr Manji. Similar symptoms could be due to a neck problem, for which the treatment would be different, so it is important to diagnose carpal tunnel syndrome accurately. Your doctor will use the following:
  • Tinel’s sign: if tapping the wrist with a reflex hammer causes tingling in the fingers, this strongly suggests CTS.
  • Phalen’s sign: another indication of CTS is asking the patient to bend their wrist to 90 degrees for a minute to see if the symptoms are brought on.
But Dr Manji considers the best guide to diagnosing CTS is to ask patients about the ‘flick sign’.”When a patient says that if they wake up in the night with symptoms they flick their wrist or hang their hand over the edge of the bed to gain relief, a CTS diagnosis is very likely.” Nerve conduction tests (NCT) (electrical studies) are then performed by a neurophysiologist to confirm the diagnosis and give an indication of the severity of the condition.

Common treatments for carpal tunnel syndrome

  • When symptoms are mild you will usually be advised to take ibuprofen or diuretic drugs to relieve the compression on the nerve in the wrist.
  • Many patients are also given a wrist splint to wear and night.
  • Steroid injections into the wrist joint are often used if these first treatments don’t relieve symptoms.
“If they don’t help or the condition is severe with weakness and wasting of muscles, surgery to cut the carpal ligament (under local anaesthetic) to relieve the pressure permanently is usually recommended,” says Dr Manji.

What does the Swedish study say?

“The Swedish study used a controlled design to see how much impact steroid injections really have in carpal tunnel syndrome. Some patients were given an 80mg dose, some a 40mg dose and some a placebo.” “The patients given the highest dose reported that their symptoms improved significantly over the next year and rates of surgery were lower in that group – 73% compared to 81% in the group given the 40mg dose and 92% in the patients given the placebo.” “So, although the injection did help and fewer patients had surgery within 12 months, three out of every four patients did need the operation.”
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