What is the efficacy of steroid injections for treatment of carpal tunnel syndrome (CTS)?

Updated: Mar 30, 2020
  • Author: Nigel L Ashworth, MBChB, MSc, FRCPC; Chief Editor: Milton J Klein, DO, MBA  more...
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Answer

Steroid injection into the carpal tunnel has been shown to be of long-term benefit and can be tried if more conservative treatments have failed. [15] Injections may also be worthwhile prior to surgical management or in cases in which surgery is relatively contraindicated (eg, because of pregnancy). [15, 35] Ultrasonographic measurements of the median nerve can help predict response to steroid injection. [36]

A double-blind, randomized, controlled study by Chen et al indicated that both direct and ultrasonographically guided corticosteroid injections in patients with idiopathic CTS lead to improvements in clinical signs and symptoms, physical function, and the majority of electrodiagnostic parameters. However, ultrasonographically guided injection in the study was associated with greater improvements in the Semmes-Weinstein monofilament test and digit 4 comparison study, as well as sensory nerve conduction velocity. [37]

A randomized clinical trial by Raeissadat et al indicated that in patients with mild to moderate CTS, a local progesterone injection produces improvement comparable to that from a corticosteroid injection, with functional outcome actually being superior to that from corticosteroid treatment. The study, which included 78 CTS patients, found no significant difference between the progesterone and corticosteroid groups with regard to factors such as pain and electrophysiologic findings, at 6-month follow-up, while functional status, as evaluated using the Boston/Levine symptom severity and functional status scale, was significantly better in the progesterone group. [38]


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