Local steroid injections only reduce inflammation temporarily

EDITOR—I am surprised that the BMJ has published the article by Dammers et al without a public health warning.1 As an orthopaedic surgeon, I occasionally use local steroid injection as temporary treatment for the carpal tunnel syndrome when operation cannot be carried out promptly. To suggest that patients should be offered steroid injection as definitive treatment, however, is both wrong and irresponsible. Pressure on the median nerve in the medium term can result in permanent damage to the nerve. Local steroid injections do not reduce the pressure on the nerve in the long term; all they do is reduce inflammation temporarily—nerve compression almost always returns, recurrence rates of 80% at one year2 and 87% at 11 months3 having been reported.

The danger with injections is that the patient feels better, believes that he or she is cured, and does not return to see the doctor for two or three years. Orthopaedic outpatient waiting lists of six months and over in the United Kingdom compound this problem. By this time the thenar muscles may be wasted and numbness of the hand in the distribution of the median nerve may have occurred; at that stage it may not respond to surgical decompression—that is, it is permanent.4

Local steroid …