BMJ 1999;319:884-886 ( 2 October )

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Injection with methylprednisolone proximal to the carpal tunnel: randomised double blind trial

J W H H Dammers, neurologist, a M M Veering, neurologist, a M Vermeulen, professor of neurology. b

a Department of Neurology, Medical Centre Alkmaar, PO Box 501, 1800 AM Alkmaar, Netherlands, b Department of Neurology, Academic Medical Centre, University of Amsterdam, PO Box 22700, Amsterdam, Netherlands

Correspondence to: Dr Dammers J.Dammers{at}mca.alkmaar.nl

Objective: To assess the effect of a 40 mg methylprednisolone injection proximal to the carpal tunnel in patients with the carpal tunnel syndrome.
Design: Randomised double blind placebo controlled trial.



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  		Fig 1.    Site for injecting corticosteroid to treat carpal tunnel syndrome

Setting: Outpatient neurology clinic in a district general hospital.
Participants: Patients with symptoms of the carpal tunnel syndrome for more than 3 months, confirmed by electrophysiological tests and aged over 18 years.
Intervention: Injection with 10 mg lignocaine (lidocaine) or 10 mg lignocaine and 40 mg methylprednisolone. Non-responders who had received lignocaine received 40 mg methylprednisolone and 10 mg lignocaine and were followed in an open study.
Main outcome measures: Participants were scored as having improved or not improved. Improved was defined as no symptoms or minor symptoms requiring no further treatment.
Results: At 1 month 6 (20%) of 30 patients in the control group had improved compared with 23 (77%) of 30 patients the intervention group (difference 57% (95% confidence interval 36% to 77%)). After 1 year, 2 of 6 improved patients in the control group did not need a second treatment, compared with 15 of 23 improved patients in the intervention group (difference 43% (23% to 63%). Of the 28 non-responders in the control group, 24 (86%) improved after methylprednisolone. Of these 24 patients, 12 needed surgical treatment within one year.
Conclusion: A single injection with steroids close to the carpal tunnel may result in long term improvement and should be considered before surgical decompression.


Key messages

  • Corticosteroid injections into the carpal tunnel may damage the nerve, and any treatment benefits may be of short duration

  • A single injection with steroids proximal to the carpal tunnel improves 77% of patients with the carpal tunnel syndrome at one month after treatment

  • This single injection is still effective at one year in half of the patients

  • Injections proximal to the carpal tunnel have no side effects and are easier to carry out than injections into the carpal tunnel




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Rapid Responses:

Read all Rapid Responses

Injection Treatment of Carpal Tunnel Syndrome
W Angus Wallace
bmj.com, 1 Oct 1999 [Full text]
anaesthesia ?
Jesús García
bmj.com, 1 Oct 1999 [Full text]
Study does not demonstrate long-term benefits of steroid injection for Carpal Tunnel Syndrome
Andrew Hayward
bmj.com, 4 Oct 1999 [Full text]
What kind of Methylprednisolon
DrMarco Brix
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Inappropriate outcome measures for assessing the improvement due to methylprednisolone injections.
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Do as we say...
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Steroid injection for CTS: which degree of severity?
Mario Casmiro
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Injections "near the carpal tunnel"
Tim Davies
bmj.com, 12 Oct 1999 [Full text]
Details of neurophysiological findings needed
Abraham Kurian
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Missing the point
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