Carpal Tunnel Injection

Treatment

What is steroid injection for carpal tunnel syndrome?
At the wrist, one of the nerves of the hand, the median nerve, and nine tendons pass through a canal called the carpal tunnel. Carpal Tunnel Syndrome is a condition in which symptoms that may include pain, tingling, numbness and weakness of the thumb are caused by compression of the median nerve in the carpal tunnel. Steroid is injected into the tunnel to relieve the symptoms of Carpal Tunnel Syndrome. Steroids have an anti-inflammatory effect and the rationale for using steroids is that they relieve inflammation within the tunnel.

How is steroid injection for carpal tunnel syndrome done?
The skin over the area through which the needle will pass is carefully prepared with an antiseptic solution. A fine needle is injected into the carpal tunnel from the front (palm) aspect of the wrist.

Where is steroid injection for carpal tunnel syndrome done?
This procedure is usually performed in a doctor’s office, no imaging equipment is required.

Who does steroid injections for carpal tunnel syndrome?
This procedure is performed by a suitably qualified and experienced doctor. This would include a General Practitioner who has an interest in musculoskeletal medicine or sports medicine.

How effective is steroid injection for carpal tunnel syndrome?
One medium quality HTA (Chapell, 2002) , two systematic reviews ranging from medium to medium to good quality (Goodyear-Smith, 2004; Marshall, 2004), seven randomised controlled trials of high, medium and medium to low quality (Armstrong, 2004; Celiker, 2002; Wong, 2001; O’Gradaigh, 2000; Dammers, 1999; Girlanda, 1993; Ozdogan, 1984), two medium quality trial follow-up studies (Armstrong, 2004; Girlanda, 1993) and one high quality case series (Weiss, 1994). In the highest quality systematic review (Marshall 2004) the authors concluded that local steroid injection provided better relief of symptoms for up to one month when compared to a placebo injection or a systemic steroid injection and up to three months when compared to oral steroids. At two months, steroid injection and oral non-steroidal anti inflammatory drugs with splinting obtained similar results. Three additional randomised controlled trials (Armstrong 2004, Girlanda 1993, Ogradaigh 2000) not reported in the systematic reviews, confirmed the effectiveness of local steroid injection compared to placebo injection providing temporary relief over a period of two weeks to three months. One non-comparative study (Weiss, 1994) of reasonably high quality also reported good short term symptom relief for some patients. The effect size appears to be small to moderate depending upon the comparison therapy.

How safe is steroid injection for carpal tunnel syndrome?
Safety and complications of therapy were reported in fifty five per cent of studies. One randomised controlled trial reported two cases (5%) of severe pain after steroid injection; one patient developed an acute sympathetic reaction.

Source: ACC

Staff

Jonathann Kuo, MD
Pain Medicine / Executive Director
Raul Cortes, MD FACS
Surgical Director / Plastic and Reconstructive Surgery
Risa Ravitz, MD
Neurology / Pain Medicine
Robert Zhang, MD
Pain Medicine / Anesthesiology
Jessica Au, MD
Sports Medicine / Pain Medicine
Tanuj Palvia, MD
Pain Medicine / Fellowship Director

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