NEWS: Shots may limit need for surgery on wrist

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Shots may limit need for surgery on wrist

Steroid injections and operations give carpal tunnel sufferers same

relief.

By January W. Payne / Washington Post

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Steroid injections provide as much relief as surgery for patients with

new cases of carpal tunnel syndrome, at least for a year after

treatment, finds a study in the journal Arthritis & Rheumatism.

Carpal tunnel syndrome -- a repetitive-use injury in which the median

nerve of the wrist compresses, causing tingling, weakness, numbness and

muscle loss in the hand and fingers -- affects an estimated 8 million

people in the United States, most of them women. Severe cases are

usually treated with surgery to decompress the nerve, according to the

National Institute of Neurological Disorders and Stroke.

The study involved 101 people, most of them middle-age women, who had

experienced symptoms for at least three months and had seen no

improvement while using nonsteroidal anti-inflammatory drugs and

splinting. Some had the condition in both wrists; as a result, the

study included 163 wrists. Roughly half were treated with surgery, the

other half with injections. (Those in the injection group received one

shot at first, then another two weeks later if nighttime symptoms --

burning or prickling sensations -- had not disappeared.)

Researchers evaluated patients' response at three, six and 12 months

after treatment. At three months, the injection group reported slightly

better relief than those who had surgery; postoperative soreness or

tenderness could account for that difference, the researchers suggest.

By 12 months, both groups reported similar relief. Researchers theorize

that the shots " reduce some grade of inflammation that could exist

around the nerve, " said the study's lead author, Andreu,

assistant head of the rheumatology unit at Hospital Puerta de Hierro in

Madrid, in an e-mail interview.

The study confirms findings that injections are effective short-term

treatments for carpal tunnel syndrome, Andreu said. More research is

needed, he said, to evaluate the shots' long-term safety and

effectiveness.

Doctors generally limit the number of steroid injections given for

other conditions -- ranging from four per lifetime for a joint with

osteoarthritis to one per month for severe rheumatoid arthritis,

according to the Mayo Clinic -- to reduce the risk of side effects,

such as infection, skin discoloration, cataracts and bone weakening.

If patients have tried two injections for carpal tunnel and don't feel

better, Andreu said, " I think that ... it is (a) better option to

decompress (through surgery) than to do more injections. "

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