Preoperative corticosteroid injections are associated with worse long-term outcome of surgical carpal tunnel release

Abstract

Background and purposeFailed closed treatment of carpal tunnel syndrome (CTS) is often followed by surgery. We investigated whether preoperative steroid injections could have a negative effect on the long-term outcome of the operation.Patients and methods174 hands (164 patients) were operated on by a single surgeon at Tartu University Hospital in 2005. The patients were interviewed by telephone 5–6 years after the operation. Self-reported data were gathered retrospectively concerning the number of steroid injections received before the surgery and the perceived regression of symptoms (on a 100-point numeric rating scale) at the time of interview. The patients were also asked about the presence of specific symptoms of CTS if regression of their symptoms had not been complete.Results93 of the 174 hands had complete regression of symptoms. Each additional injection was associated with an increased risk of occurrence of pain (RR = 1.1, 95% CI: 1.02–1-2), paresthesiae (RR = 1.1, CI: 1.1–1.2), and nocturnal awakenings (RR = 1.2, CI: 1.1–1.3). There was a weak association between the number of injections and the score given to regression of symptoms.InterpretationThis is the first study to indicate that patients who received a greater number of local steroid injections preoperatively were more likely to have postoperative complaints associated with CTS.

Analysis of Expected Costs of Carpal Tunnel Syndrome Treatment Strategies

“…1 Although authors have suggested that a steroid injection reduces the need for further surgery, other studies have advocated for immediate surgical release as a more cost-effective treatment option. 5,23,26 Regardless, recent literature has shown that nationwide practice varies, as does the reported success rate of steroid injections, and that initial steroid injection may reduce the number of surgical releases eventually performed. 11,12,24 The purpose of this study is to use the previously described payer perspective to assess the relative costs of different treatment options: either immediate surgical release or up to 3 attempted injections.…”

Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial

“…13 However, 1 study conducted in Estonia reported that patients who received repetitive steroid injections were more likely to have postoperative symptoms of carpal tunnel syndrome if they eventually opted for surgery. 14 Acupuncture is commonly used to manage pain and neuropathy in Chinese medicine. A systematic review published in 2011 included 2 trials that compared acupuncture and steroid injection; acupuncture was found to be slightly better in reducing symptoms of carpal tunnel syndrome.…”

Does prior local corticosteroid injection prejudice the outcome of subsequent carpal tunnel decompression?

“…It did not however, affect overall patient satisfaction with the surgical outcome. This study is substantially larger than the 164 patients reported by Vahi et al (2014) and both initial patient variables and outcomes are documented using standard instruments.…”