Corticosteroid Injections Not as Effective as Surgery in Treatment of Carpal Tunnel Syndrome

Newswise — 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."

The American College of Rheumatology is the professional organization for rheumatologists and health professionals who share a dedication to healing, preventing disability and curing arthritis and related rheumatic and musculoskeletal diseases. For more information on the ACR's annual meeting, see http://www.rheumatology.org/annual.

Editor's Notes: Dr. Ly-Pen will present this research during the ACR Annual Scientific Meeting at the Boston Convention and Exhibition Center from 8:00 " 9:00 am ET on Saturday, November 10, 2007, in the Exhibit Hall. Dr. Ly-Pen will be available for media questions and briefing at 1:30 pm ET on Friday, November 9 in the on-site press conference room, Room 251.

Presentation Number: 1646

Long-Term Outcome of Local Corticosteroid Injection vs. Surgery in Carpal Tunnel Syndrome: An Observational Extension of a Randomized Clinical Trial

Domingo Ly-Pen1, José-Luis Andreu2, Isabel Millán3, Gemma de Blas4, Alberto Sánchez-Olaso5. 1Centro de Salud Gandhi, Madrid, Spain; 2Rheumatology Unit. Hospital Universitario Puerta de Hierro, Madrid, Spain; 3Biostatistics. Hospital Universitario Puerta de Hierro, Madrid, Spain; 4Neurophysiology Unit. Hospital Universitario Ramón y Cajal., Madrid, Spain; 5Plastic Surgery Unit. Hospital Universitario Ramón y Cajal., Madrid, Spain

Purpose: We have demonstrated that local injection (I) of corticosteroids for carpal tunnel syndrome (CTS) is as effective as decompressive surgery (S), after a follow-up of one year. In this study, we assess the long-term outcomes of both therapies in an observational extension of the patients originally enrolled in the randomized clinical trial.

Methods: Patients were originally enrolled in an open, randomized clinical trial, comparing I vs. S in CTS. After the end of the clinical trial, patients received the standard of care, according to his/her clinician's opinion. Therapeutic failure was defined as the need of any new therapeutic intervention on the affected wrist. Comparison between the groups was made using Cox multiple regression analysis. The estimation of the accumulated incidence of the event was made considering the withdrawn as a competitive risk (Gooley´s test).

Results: One hundred and forty eight of the 163 randomized wrists at the beginning of the study were available in the follow-up. The median follow-up was 5.9 years. In the estimation at 7 years, the accumulated incidence of therapeutic failure in group S was 11.6% vs. 41.8% in group I. The Cox multiple regression analysis showed a risk of failure associated with I of 4.5 (CI 95%: 2,09-9,86; P < 0.0001).

Conclusions: In long term follow-up, surgery seems more effective than local injections of corticosteroids in primary CTS, although more than fifty percent of patients will not need more therapeutic interventions during the follow-up.

Disclosure Block: D. Ly-Pen, None; J. Andreu, None; I. Millán, None; G. de Blas, None; A. Sánchez-Olaso, None.