How effective are steroid injections?

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

They found that symptoms improved in many people within the first 2 to 4 weeks after having the treatment: The symptoms got better in

• about 30 out of 100 people who didn't have a steroid injection, and in
• about 75 out of 100 people who had a steroid injection.

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

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 are also always associated with a risk of infection. An infection may damage tendons and nerves. Serious complications such as inflammation affecting the entire hand are quite rare. If the injection isn't given properly, 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 improvement last?

Previous research suggests that the benefits of steroid injections are still noticeable ten weeks later. Steroid injections 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 steroid treatment, but steroid injections sometimes help to avoid surgery or put it off for a while. It is also possible to have steroid injections again at regular intervals. 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 steroid tablets?

Steroid 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. But steroid tablets can cause side effects, including stomach problems, skin problems, or weight gain.

Sources

• Atroshi I, Flondell M, Hofer M, Ranstam J. Methylprednisolone injections for the carpal tunnel syndrome: a randomized, placebo-controlled trial. Ann Intern Med 2013; 159(5): 309-317. [PubMed: 24026316]
• Bland JD. Carpal tunnel syndrome. BMJ 2007; 335(7615): 343-346. [PMC free article: PMC1949464] [PubMed: 17703044]
• Chen PC, Chuang CH, Tu YK, Bai CH, Chen CF, Liaw M. A Bayesian network meta-analysis: Comparing the clinical effectiveness of local corticosteroid injections using different treatment strategies for carpal tunnel syndrome. BMC Musculoskelet Disord 2015; 16: 363. [PMC free article: PMC4653918] [PubMed: 26585378]
• Deutsche Gesellschaft für Handchirurgie (DGH), Deutsche Gesellschaft für Neurochirurgie (DGNC). S3-Leitlinie: Diagnostik und Therapie des Karpaltunnelsyndroms. AWMF-Registernr.: 005-003. June 2012.
• Huisstede BM, Randsdorp MS, Coert JH, Glerum S, van Middelkoop M, Koes BW. Carpal tunnel syndrome. Part II: effectiveness of surgical treatments - a systematic review. Arch Phys Med Rehabil 2010; 91(7): 1005-1024. [PubMed: 20599039]
• Huisstede BM, Randsdorp MS, van den Brink J et al. Effectiveness of Oral Pain Medication and Corticosteroid Injections for Carpal Tunnel Syndrome: A Systematic Review. Arch Phys Med Rehabil 2018; 99(8): 1609-1622. [PubMed: 29626428]
• Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev 2007; (2): CD001554. [PubMed: 17443508]
• Shi Q, MacDermid JC. Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? A systematic review. J Orthop Surg Res 2011; 6: 17. [PMC free article: PMC3080334] [PubMed: 21477381]

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