Do corticosteroids improve surgical outcomes for carpal tunnel syndrome?

carpal tunnel syndrome

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In a recent study, researchers in China compared the effectiveness of corticosteroids in the treatment of carpal tunnel syndrome.

Carpal tunnel syndrome is a disorder caused by the compression of the median nerve sandwiched within the carpal tunnel of the wrists. This leads to pain, numbness, and tingling in the hand. Strenuous and heavy work involving the wrists, obesity, and rheumatoid arthritis are some risk factors that increase an individual’s chances of developing carpal tunnel syndrome.

Managing carpal tunnel syndrome

In moderate cases, doctors recommend splinting, corticosteroids, and physical therapy to manage carpal tunnel syndrome. In severe conditions, surgical intervention may be necessary.

Surgery for carpal tunnel syndrome involves gently severing the transverse carpal ligament (TCL) to expand the carpel tunnel volume to reduce the pressure on the median nerve. Surgeons can use, any methods can to access the carpal tunnel. However, endoscopic and ultrasound-guided methods are popular because they are less invasive compared to open surgeries.

Researchers in China recently investigated whether corticosteroids improve surgical outcomes of a procedure for carpal tunnel syndrome. The results were recently published in the Journal of Orthopaedic Surgery and Research.

Are corticosteroids effective?

The one-year prospective study conducted from June 2016 to June 2017 included 49 patients. Among the patients, there were 50 wrists with severe carpal tunnel syndrome. Of these, doctors treated 25 with a procedure called an ultrasound-guided release of the transverse carpal ligament. The remaining patients were treated with the same procedure as well as corticosteroid injections during the surgery.

The researchers assessed the outcomes of the procedure and treatment three months after surgery. The patients were around 49 years old, with an average history of carpal tunnel syndrome of 20 months. The study included 12 males and 38 females.      

Corticosteroids improved surgical outcomes

The outcome was labelled “very good” in 84% in patients treated with the combination approach surgery (ultrasound guided TCL release and corticosteroids). The outcome was labelled “good” in only 52% of patients treated with TCL surgery alone (TCL release only).

Interestingly, measures of speed and responsiveness of the median nerve affected by carpal tunnel syndrome were significantly better in the surgery employing the use of corticosteroids. Swelling was also significantly different in two approaches; favouring the use of corticosteroids.

Corticosteroids may be helpful for ultrasound-guided transverse ligament release surgery

The results of the study suggest that the use of corticosteroids injections during ultrasound-guided transverse ligament release surgery is potentially better than the use of transverse ligament release alone.

The authors hinted at the potential explanations for these improvements. Whereas the transverse ligament relieves the pressure on the median nerve, promote blood circulation, and promotes axonal regeneration, the corticosteroids act by reducing the edema and inflammation, accelerating collagen degradation and reducing scar formation.

However, investigators offer a word of caution, noting that the procedure requires the surgeon to be highly skilled in musculoskeletal sonography and ultrasound-guided procedures. The location of key nerves such as the ulnar artery, ulnar nerve, radial artery, and radial nerve also need to be verified precisely. The investigators also noted that since corticosteroid use is restricted in some patients, it is imperative that further investigations are required to for defining the right patient population for this procedure.

Written by Vinayak Khattar, Ph.D., M.B.A.

Reference: Guo, X. Y., Xiong, M. X., Lu, M., Cheng, X. Q., Wu, Y. Y., Chen, S. Y., . . . Chen, Q. (2018). Ultrasound-guided needle release of the transverse carpal ligament with and without corticosteroid injection for the treatment of carpal tunnel syndrome. J Orthop Surg Res, 13(1), 69. doi:10.1186/s13018-018-0771-8

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