BOSTON, Massachusetts—Carpal tunnel outcomes with early decompression surgery are three times better than those after local injections of corticosteroids, according to research presented at the American College of Rheumatology Annual Scientific Meeting in Boston.¹

"Surgery was three times more effective than steroids in the long term," said lead researcher Domingo Ly-Pen, MD, PhD, a family physician at Gandhi Health Center in Madrid.

At 5.9 year follow-up, surgery looks better

The new study looked at the long-term outcomes of both surgery and corticosteroid injections in an observational extension of patients who were originally enrolled in a clinical trial comparing the two treatment modalities. Both treatments were equally effective after 1 year, but differences became apparent over long-term follow-up.

Overall, 148 of the original 163 randomized wrists were available for follow-up.
At an average follow-up of 5.9 years, 41.8% of participants who received corticosteroid injections needed additional treatment, whereas only 11.6% of participants who underwent surgery needed additional treatment. "Therefore, surgery appears to be more effective than injections in the long-term," the researchers concluded.

"Does everyone need surgery? No, but more people than we realize do," said Eric Matteson, MD, professor of medicine at the Mayo Clinic in Rochester, Minnesota. "We probably need to begin considering surgery more often and earlier than we do now because the outcome would be better if we did surgery upfront. Steroids may be more of a Band-Aid," Dr. Matteson added. "These findings may not apply to patients who have carpal tunnel syndrome due to rheumatoid arthritis. In RA, if you get the swelling down and get it under control, you probably won't have to do surgery at all."

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