This is a question that I get asked quite often and it is not always an easy one to answer because there is context and contingencies that need to be addressed before any answer can be given definitively.
First, a little bit about steroid injections. Giving the steroid is a standard nonsurgical treatment for carpal tunnel syndrome, and it is usually well tolerated, even though for some people it can be somewhat painful.
Several different types of steroids can be used for the injection. They vary in their potency as well as their chemical nature, but essentially, for practical purposes, they are all just about the same.
I like to use one called Celestone (the generic name as betamethasone), but other surgeons like to use different steroids such as Depo-Medrol or Kenalog.
If a person has carpal tunnel syndrome and does not necessarily want surgery and conservative measures like night splinting, physical therapy, massage and over-the-counter medications have not helped then a person can become a candidate for a steroid injection.
The steroid is mixed with lidocaine, a numbing agent, and then injected into the carpal tunnel in order to help reduce swelling among the tendons that might be swollen as well as the nerve itself.
It is very important to get someone who understands the anatomy very clearly to give you a steroid injection. The fact of the matter is that steroid injections are not 'intuitive' and 'easily done' with little or no training. They take a particular understanding of the anatomy, as well as specific instructions which are given to the patient in order to avoid intra-neural injection.
This means when the medicine is injected directly into the nerve rather than around the nerve. A person who has had inadvertant injection of medicine into the nerve can sustain a nerve injury which can be permanent requiring surgery and may disable them in the future.
Intra-neural injection is a very serious condition that I have seen a few times painfully only in my surgical career and I would like to see it no more; however, it does occur, especially in inexperienced hands.
Thankfully though, the more likely scenario is that somebody who is inexperienced with giving steroid injections will simply not know where to place the medication and may become a little bit 'chicken' and simply not give the medication in the correct place, resulting in no relief of pain.
I have patients that come to my office and say that the carpal tunnel injections did not work. What is worse is that that the injection itself can be very painful, so the fact of the matter is they do not want another steroid injection because of the pain of the injection process itself. This is understandable.
Many times, I tell patients not to get a steroid injection and proceed directly to surgery because it is a definitive step in the properly selected patients and will relieve the pain in the majority (meaning 95% to 99%) of instances.
But to make this decision you have to know your patient very well and know the anatomy very well and you have to understand if your conservative treatments are working or not.
The fact of the matter is that the steroid injections are not permanent. At best they last two to three months and in fact 80% of same people who receive a steroid injection will have their symptoms return within a year and in my clinical practice that number is probably higher on the order of 90% to 95%.
In short, steroids are not a permanent solution, but they can delay the need for surgery especially if a patient wants to keep working for a little bit of time or has a personal/family issue that they would like to take care of before they undergo surgery.
This is completely reasonable and is something that I see quite frequently because as a hand surgeon you simply do not treat the hand, you treat the person and as a doctor, you try to treat the whole person and take the big picture into account.
I always stress in addition to all the standard conventional nonsurgical methods of treating carpal tunnel syndrome before considering surgery.
I stress on nutritional solutions which include proper diet, lifestyle and alternative forms of therapy such as yoga as well as specific supplementation that helps with the metabolism of nerves in general like the vitamins Coenzyme, Q10 omega 3, fatty acids, etc.
I always try to look at the whole picture and although I am not against any of the conventional surgical methods of treating carpal tunnel syndrome, I do feel many long-term cures rest on the pillars of diet and lifestyle, that is you should always proceed with more invasive and risky procedures like carpal tunnel surgery or harsh medications or steroid injections only after you have tried the proper dietary and lifestyle interventions.
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