Injection with methylprednisolone for carpal tunnel syndrome

doi:10.1136/bmj.320.7235.645/a

BMJ 2000;320:645 ( 4 March )

Letters

Injection with methylprednisolone for carpal tunnel syndrome

Local steroid injections only reduce inflammation temporarily

Study does not show long term benefits of injection for the syndrome

Study is needed to determine best treatment for this syndrome

Author's reply

Local steroid injections only reduce inflammation temporarily

The first 150 words of the full text of this article appear below.

EDITOR $---$ I am surprised that the BMJ has published the article by Dammers et al without a public health warning.¹ As an orthopaedicsurgeon, I occasionally use local steroid injection as temporarytreatment for the carpal tunnel syndrome when operation cannotbe carried out promptly. To suggest that patients should be offeredsteroid injection as definitive treatment, however, is both wrongand irresponsible. Pressure on the median nerve in the mediumterm can result in permanent damage to the nerve. Local steroidinjections do not reduce the pressure on the nerve in the longterm; all they do is reduce inflammation temporarily $---$ nerve compressionalmost always returns, recurrence rates of 80% at one year²and 87% at 11 months³ having beenreported.

The danger with injections is that the patient feels better, believes that he or she is cured, and does not return to seethe doctor for two or . . . [Full text of this article]

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Relevant Article

Injection with methylprednisolone proximal to the carpal tunnel: randomised double blind trial: J W H H Dammers, M M Veering, and M Vermeulen
BMJ 1999 319: 884-886. [Abstract] [Full Text] [PDF]

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