Office workers and text message-addicted teens know all too well the perils of carpal tunnel syndrome. A shooting pain through the forearm and hand makes full dexterity unbearable, and near impossible. According to a new study published in the Annals of Internal Medicine, relief is a steroid shot away — although, for most people, surgery may still be one year down the line.
Carpal tunnel syndrome (CTS) affects three to six percent of adults in the general population, according to the American Academy of Family Physicians. The pain involved with the condition derives from a compressed median nerve — a long, thin nerve running from the forearm to the base of the hand inside the carpal tunnel. It controls motor function in the base of the thumb and provides sensation to the palm side of the hand. Sufferers of CTS must often wear a wrist splint or take anti-inflammatory drugs, both of which control the swelling inside the tunnel. Recent research suggests steroid injection delivers prolonged relief as well.
Some experts believe the recent study merely confirms what doctors have already practiced for years. Dr. David Ruch, chief of orthopedic hand service at Duke University Medical Center, believes the new research bolsters the theory that steroid use acts as a temporary fix for moderate to severe cases of CTS.
"The long-term ability of carpal tunnel syndrome to be treated with an injection is really based upon the severity of your symptoms, how long the symptoms have been in place and how old you are," he said.
Three out of four patients in the study, which was conducted by doctors from Hassleholm Hospital in Sweden, required surgery within one year following their shot. None of the 111 participants, who were aged 18 to 70, reported having had steroid shots prior to the study. Many had unsuccessful experiences with wrist splits in the past.
"You have a reasonable chance of having your symptoms go away and stay gone with the cortisone shot,” Ruch said of people under 30 with mild symptoms of CTS. In people over 35, moderate to severe cases of CTS will see effects last six months. Beneficial effects from the cortisone shot were reported as early as 10 weeks after injection, with participants experiencing less pain, tingling, and numbness.
Steroids work in treating CTS largely because of their anti-inflammatory processes. When the carpal tunnel swells, as a result of overuse, poor ergonomics, and overall stress in the region, the nerve pinches and movement becomes inhibited. Steroid shots reduce the pressure applied to the median nerve, at least temporarily. In patients whose symptoms resurfaced within the year, surgeons removed the pressure by cutting into the tunnel and releasing the nerve.
Steroid shots also work as a good litmus test for determining who needs surgery and who doesn’t. Depending on the patient’s physiological response, doctors can see the steroid’s effectiveness and decide if surgery is the best course of action.
"Injection is a crucial and important part of treating patients with carpal tunnel syndrome initially, because it helps confirm the diagnosis," said Dr. Leon Benson, of the Illinois Bone & Joint Institute in Glenview, Ill. "I never operate on anyone unless I've given them a steroid injection first."
And according to Benson, HealthDay reports, overall response to steroid injection can predict a person’s response to surgery, thus giving steroid shots an added benefit even if the effects are only temporary.
"It does a very nice job of delineating who is going to have a good response to surgery," he said. "If you had good relief from your cortisone shot, chances are very, very high you're going to get good results from surgery."