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Carpal tunnel syndrome: How effective are corticosteroid treatments?

Created: ; Last Update: November 16, 2017; Next update: 2020.

Treating carpal tunnel syndrome symptoms with corticosteroids can provide temporary relief. Corticosteroid injections into the carpal tunnel are more effective than corticosteroids taken as tablets.

Pain, tingling or numbness in your hand may possibly be caused by carpal tunnel syndrome. In carpal tunnel syndrome, the median nerve that runs through the carpal tunnel in your wrist is squashed. This nerve leads to the ball of the thumb and other parts of the hand. Injecting corticosteroids (steroids) is one of the most effective treatments available.

Natural steroids are made in the adrenal glands. They have various effects, such as reducing inflammation and swelling. The steroids used in medications are made artificially. In the treatment of carpal tunnel syndrome, corticosteroids are typically considered if wearing a splint hasn't made any difference. The corticosteroid can either be injected into the tissue as a solution or taken as a tablet. The injections are more common and more effective than the tablets.

How effective are corticosteroid injections?

Injecting corticosteroids near the carpal tunnel is a common treatment. Steroids reduce swelling in the connective tissue, which relieves the pressure on the median nerve. The benefits of corticosteroid injections have been tested in several studies. In these studies, the corticosteroid injections were compared with either non-surgical treatments or injections that didn't contain any medication (placebo injections).

They found that symptoms improved in many people within the first 2 to 4 weeks of treatment:

  • Symptoms improved on their own in about 30 out of 100 people.
  • Symptoms improved after corticosteroids were injected in about 75 out of 100 people.

In other words, the treatment provided noticeable short-term relief from symptoms in about 45 out of 100 people.

One of the studies suggests that giving a single injection is just as effective as dividing the dose between two injections given eight weeks apart.

What are the possible side effects?

The injections can temporarily cause mild or moderate pain in the hand, but it disappears after a few days. Injections also increase the risk of infection in general. An infection may damage tendons and nerves. Serious complications such as inflammation affecting the entire hand are quite rare. If the injection is done wrong the nerves may be damaged. But this is estimated to occur in fewer than 1 out of 1,000 cases. Overall, serious side effects are very rare.

How long will the effect last?

Previous research suggests that corticosteroid injections still have an effect ten weeks later. They aren't effective in the long term, though. The symptoms often return after a while.

Some people who have very persistent symptoms may consider surgery. Surgery is often more effective than regular corticosteroid treatment, but the corticosteroid injections might help to avoid surgery or put it off for a while. It is also possible to start having regular corticosteroid injections again after surgery. It isn't clear how effective or safe this is over the long term, though. Regular injections are thought to possibly increase the risk of nerve and tendon damage as well as other side effects.

How effective are corticosteroid tablets?

Corticosteroid tablets can somewhat relieve carpal tunnel syndrome in some people. They may be worth trying if you have symptoms for the first time and they aren't too severe. People are advised not to take the tablets for over two weeks because longer use probably doesn't offer any benefits. Corticosteroid tablets may also cause side effects, including stomach problems, skin problems, or weight gain.

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