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Long-Term Effectiveness of Corticosteroid Injections for Carpal Tunnel Syndrome.
Stefanie Evers, MD; Andrew Bryan, MD; Thomas Sanders, MD; Tina Gunderson, MS; Russell Gelfman, MD; Peter C. Amadio, MD
Mayo Clinic, Rochester, MN
Introduction: Corticosteroid injection is frequently used to treat carpal tunnel syndrome (CTS). However, the role of steroid injections in the treatment of CTS is still controversial since there is only strong evidence for benefits in the short-term [1-3]. The purpose of this study was to assess the long-term response to corticosteroid injections in the management of CTS while identifying prognostic indicators for subsequent treatment.
Materials & Methods: This study evaluated residents of Olmsted County, MN, USA, treated with a corticosteroid injection for CTS between 2001 and 2010. Follow-up data was collected to 31/12/2014. Failure of treatment was the primary outcome of interest. Two definitions for failure were examined: 1) subject receiving either subsequent injection or carpal tunnel release on the injected wrist and 2) subject undergoing carpal tunnel release on the injected wrist. The risk factors of interest were age, gender, injectate volume, effective dose of steroid, history of diabetes, peripheral neuropathy, rheumatoid arthritis or other relevant comorbidities, and EMG severity. Kaplan-Meier analysis and Cox regression modeling were used to estimate treatment failure rates.
Results: There were a total of 792 observations in 609 distinct patients. The cohort was 30.2% male. Mean (SD) age at injection was 50.7 (13.6), used an average injectate volume of 3.7 mL (1.2) and average steroid dose (standardized to effective dose of triamcinolone) of 39.9 mg (22.3). For EMG severity, 23% were classified as normal or were not tested, 71% as mild or moderate severity and 6% as severe. The median follow-up period was 7.3 years (min 7 days, max 12.6 years). Overall, subsequent treatment was performed in 68% of cases (N=536), with eventual surgery in 63% of cases (N=496). Median time to failure was 260 days for any retreatment and 441 days for surgery. Injectate volume was significant for the outcome of any retreatment (hazard ratio (HR) 0.876[0.802-0.96]) and surgery (HR 0.903[0.825-0.99]). Rheumatoid arthritis was also significant in both models, with HR 0.625[0.402-0.97] for any retreatment and HR 0.484[0.287-0.82] for surgery.
Conclusion: In this population-based cohort, even with median follow-up of 7.3 years, 32% of the subjects did not receive subsequent treatment after a single steroid injection. This result indicates that there is a role for corticosteroid injections in the treatment of CTS. Further research is necessary to identify those patients who will benefit in the long term from a corticosteroid injection, in order to provide more individually tailored treatment for patients with CTS.
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