Injections Best for Carpal Tunnel Syndrome

Comparison study finds less invasive treatment for painful condition works well

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HealthDay Reporter

THURSDAY, Feb. 3, 2005 (HealthDay News) -- In the first-ever comparison of the two most common treatments for carpal tunnel syndrome, Spanish researchers conclude that simple steroid injections bring most people long-term relief that's equal to, or better than, invasive surgery.

"In the absence of weakness or muscle atrophy, a local injection is as effective and safe as surgery," said study author Dr. Jose Luis Andreu, of the Rheumatology Unit at Hospital Puerta de Hierro, in Madrid.

Steroid injections are also "cheaper and more feasible" than invasive surgery for the painful condition, which is brought on by repeated stress on the wrist, he added.

"In fact, the results at three months are slightly better with injection," he said.

The findings, published in the February issue of Arthritis & Rheumatism, came as no surprise to Melissa Peavey, a Dallas-based occupational therapist and certified hand therapist.

"The surgeons I work with always try an injection first, unless it's a longstanding situation," said Peavey, who is also a spokeswoman for the American College of Rheumatology. She said surgery is usually performed only in advanced cases, where hand and finger muscles have atrophied.

According to a recent study, almost 3 percent of adults may be affected by carpal tunnel syndrome, which is caused by inflammation and pressure on nerves and ligaments running through the wrist to the hand. People often experience tingling, burning or numbness in the affected hand, and may also lose the ability to flex or grip objects.

For years, experts believed that repetitive movements, especially in the workplace, were the cause of most carpal tunnel cases. But Peavey said another factor is emerging as a prime culprit: sleep.

"Holding your wrist all night in a flexed position -- if you ever go to bed and keep your hands all tucked up under your chin, for example. People can sleep like that for a long time, and it puts pressure on that area at night," she explained.

For many patients, simply wearing a splint at bedtime that straightens out the hand can bring relief, Peavey said. But for other patients, two treatments remain: local injections of anti-inflammatory steroids, and surgery.

"When you inject steroids, you're in a specific area of the transverse carpal ligament," Peavey explained. "Over time, that steroid keeps on working to keep inflammation down."

With surgery, doctors tackle the problem by cutting away at the transverse ligament that crosses the wrist, relieving pressure on adjacent nerves.

"What we're really talking about... is a [clogged] tunnel. So, you've got to either make the tendon smaller via injection, or you make the tunnel bigger with an incision," Peavey said.

But which of these approaches is the best course of action?

In their study, Andreu and his team examined one-year outcomes in 163 carpal tunnel-affected wrists belonging to a total of 101 patients. About half of the wrists were treated with surgery, while the other half received local steroid injections.

The result: Three months after treatment, 94 percent of wrists in the injection group achieved significant improvement in terms of pain relief and renewed movement, the researchers report. That percentage declined somewhat over time, however, to 85.5 percent by six months after injection and 70 percent one year after treatment.

However, clinical outcomes following surgery didn't match those numbers, especially in the short term.

Three months after surgery, just 75 percent of wrists showed significant improvement, the study found. That number fell to 70 percent by one year after the operation, the researchers report.

Patients who receive injections usually "do very nicely," Peavey noted, especially since "they feel immediate relief." For most, the relief will last: Peavey said the usual protocol is to have patients return for a check-up in a few weeks, "but a lot of people never return because the steroid is working, they feel great and just cancel the appointment."

More information

For more on carpal tunnel syndrome, go to the National Institute of Neurological Disorders and Stroke.

SOURCES: Jose Luis Andreu, M.D., Rheumatology Unit, Hospital Puerta de Hierro, Madrid, Spain; Melissa Peavey, occupational therapist and certified hand therapist, Dallas, and spokeswoman, American College of Rheumatology; February 2005 Arthritis & Rheumatism

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