Carpal Tunnel Syndrome (CTS) occurs when the median nerve which runs from the forearm into the hand becomes pressed or squeezed at the wrist. This results in pain, weakness, or numbness in the hand and wrist, radiating up the arm.
Why surgery is more superior treatment for Carpal Tunnel Syndrome than local steroid injections?
Treatment with surgery was significantly more effective than local steroid injection in alleviating symptoms of carpal tunnel syndrome (CTS) over a 2-year follow up period, a Spanish study has found.
The primary end point at 2-year follow-up was the percentage of wrists that reached a >20 percent improvement in the visual analogue scale score for nocturnal paresthesia. Both treatment groups had comparable severity of CTS at baseline.
Fifty-five wrists in the surgery group and 48 wrists in the injection group completed the follow-up. In the intent-to-treat analysis, 60 percent of the wrists in the injection group and 69 percent in the surgery group achieved a 20 percent response for nocturnal paresthesia (P<0.001).
Although the clinical relevance of those differences remains to be defined, the findings are not entirely unexpected as each of the two procedures has its own benefits and disadvantages, said Dr. Chew Li-Ching, consultant in the department of rheumatology and immunology at Singapore General Hospital (SGH).
“The injection can be easily…delivered at the point of care. However, usually, it provides temporary relief only compared with surgery. At SGH, we are well supported by hand surgeons, [therefore] access to surgery has not proven to be an issue,” said Chew.
“Injection is still an acceptable standard of care for CTS, especially if the patient’s symptoms and findings on neurophysiological testing are mild to moderate. The more severe cases such as those associated with weakness and muscle wasting would usually warrant surgery.”
Although randomization based on wrists rather than patients could be considered the study’s limitation, CTS is often a bilateral condition and the approach is consistent with the standard of care in clinical practice which consists of treating both wrists in cases of bilateral CTS, said the researchers.
“We also felt that by randomizing only the most symptomatic wrist in the bilateral cases, we could have a biased selection [and] the results of the study would not represent the real severity of CTS in the general population…it would transform CTS into a more severe disease than it really is.”