Surgical decompression versus local steroid injection in carpal tunnel syndrome: A one‐year, prospective, randomized, open, controlled clinical trial

Abstract

Objective. Optimal treatment of carpal tunnel syndrome (CTS) has not been established. This study compared the effects of local steroid injection versus surgical decompression in new-onset CTS of at least 3 months' duration.Methods. In a 1-year, prospective, randomized, open, controlled clinical trial, we studied the effects of surgical decompression versus local steroid injection in 163 wrists with a clinical and neurophysiologic diagnosis of CTS. Clinical assessments were done at baseline and at 3, 6, and 12 months after treatment. The primary end point was the percentage of wrists that reached a >20% improvement in the visual analog scale score for nocturnal paresthesias at 3 months of followup. Statistical analysis was done by Student's t-test for continuous variables and by chi-square test for categorical variables. Analyses were performed on an intent-to-treat basis. P values less than 0.05 were considered statistically significant.Results. Both treatment groups had comparable severity of CTS at baseline. Eighty wrists were randomly assigned to the surgery group and 83 wrists to the local steroid injection group. In the intent-to-treat analysis, at 3 months of followup, 94.0% of the wrists in the steroid injection group versus 75.0% in the surgery group reached a 20% response for nocturnal paresthesias (P ‫؍‬ 0.001). At 6 and 12 months, the percentages of responders were 85.5% versus 76.3% (P ‫؍‬ 0.163) and 69.9% versus 75.0% (P ‫؍‬ 0.488), for local steroid injection and surgical decompression, respectively.Conclusion. Over the short term, local steroid injection is better than surgical decompression for the symptomatic relief of CTS. At 1 year, local steroid injection is as effective as surgical decompression for the symptomatic relief of CTS.

Comparison of short-term clinical and electrophysiological outcomes of local steroid injection and surgical decompression in the treatment of carpal tunnel syndrome running title: steroid injection and surgical decompression in carpal tunnel syndrome

“…They also stated that effectiveness of steroid injections decreased at 1 st year, whereas owing to favourable outcomes of steroid injections Despite controversial outcomes in the literature, local steroid injections have been thought to provide as effective symptomatic improvement as surgical methods at least in the short term. Also in our study, local steroid injection was found to be as successful as surgical decompression, which is in accordance with short-term outcomes reported in the literature (5,18,30).…”

“…94 vs. 75%; 85.5 vs. 76.3%, and 69.9 vs. 75 %, respectively (18). The authors indicated that local steroid injections had provided better symptomatic improvement in the short-term, while it was as effective as surgical decompression in the 1 st year of the treatment.…”

Diagnosis, treatment and follow-up of the carpal tunnel syndrome: a review

“…There are three randomised controlled studies that compare surgical versus conservative treatment [40][41][42], two of which were included in a systematic Cochrane review [43]. In the studies included in the review [40,42], the non-surgical group had been treated by hand-wristforearm splinting for 4 or 6 weeks.…”

“…The reviewers concluded that, although short-term (1 month) statistical data were only mildly significant, surgical treatment is more effective than conservative therapies in preserving mid-to long-term improvement [43]. In the study by Ly-pen et al [41], the non-surgical group underwent steroid treatment by local infiltration. Surgical treatment was significantly less effective in improving symptoms after 3 months (percentage of subjects with improvement equal to or higher than 20%; nocturne paraesthesia: 94% with corticosteroids vs. 75% after surgery; daytime pain: 89 vs. 69%; compromised function: 88 vs. 68%).…”

Carpal Tunnel Syndrome

“…Other studies have shown better improvement of symptoms after surgery at five months compared to people treated with injections. 32,33 Endoscopic carpal tunnel surgery has a faster recovery time compared to open carpal tunnel release. The difference is about 2 to 3 weeks sooner to go back to work.…”