Methylprednisolone injections significantly reduce pain and improve function in carpal tunnel syndrome (CTS) in the short term, but only slightly reduce the rate of surgery after one year.
CTS is a common condition in which there is excessive pressure on the nerve in the wrist that allows feeling and movement to parts of the hand. Patients are initially treated with wrist splinting, but many go on to have surgery. While surgery often produces good outcomes, recovery can last several weeks and includes lost work time. Thus, finding an effective nonsurgical treatment is desirable.
The majority of hand surgeons report using steroid injections to alleviate CTS symptoms and prevent surgery, but evidence of long-term benefit is lacking.
Researchers sought to determine the efficacy of local methylprednisolone injections in CTS. Three groups of 37 patients each who had CTS but no previous steroid injections were randomly assigned to receive either 80 mg of methylprednisolone, 40 mg of methylprednisolone, or placebo. At 10 weeks, patients in the 80 mg group reported the most improvement in CTS symptom severity scores.
At one year, patients who received 80 mg of methylprednisolone had a lower likelihood of having surgery than those receiving 40 mg or placebo. However, three out of four patients in the trial had surgery within one year. Time from injection to surgery was longer for the 80 mg group than 40 mg or placebo.
"Methylprednisolone Injections for the Carpal Tunnel Syndrome: A Randomized, Placebo-Controlled Trial" Isam Atroshi, MD, PhD; Magnus Flondell, MD; Manfred Hofer, BSc; and Jonas Ranstam, PhD, Ann Intern Med. 2013;159(5):309-317. doi:10.7326/0003-4819-159-5-201309030-00004