Surgery or injections: Which is the better option?

Consider costs, complications for carpal tunnel

Over the long term, surgery may be a better treatment option than local injections of corticosteroids when treating carpal tunnel syndrome, according to a recent study.1

Researchers assessed long-term outcomes of surgery and corticosteroid injections in carpal tunnel sufferers. After three months, local injections were better than surgery. At the one-year mark, both treatments were equally effective; at the seven-year mark, however, surgery showed better results.

"Nonetheless, more than 50% of the initially injected wrists did not need further treatment," says Domingo Ly-Pen, MD, PhD, the study's lead investigator and a family physician at Gandhi Health Center in Madrid, Spain.

In addition, surgery is more likely to have a higher complication rate than a less invasive procedure such as injection, notes Shawn Marshall, MD, a specialist in physical medicine and rehabilitation at the University of Ottawa.

Direct and indirect costs also must be taken into account. For instance, patients are often unable to work for a number of weeks post-surgery, whereas post-injection this is not the case, says Marshall. "It may be worthwhile to do an economic health evaluation before considering surgery as definitive treatment for all cases," he says.

The study's findings actually suggest that injections should be used for initial treatment, says Kurt T. Hegmann, MD, MPH, director of the Salt Lake City-based Rocky Mountain Center for Occupational & Environmental Health. "Most patients getting an injection never needed additional treatment," he says. "If the symptoms return, the treatment options begin to switch, and surgery becomes a more likely requirement if more injections are required. If they were my hands, I would opt for an injection."

In addition, other more conservative treatments often help decrease or eliminate symptoms and the need for surgery, notes Joanne Kassimir, OTR, CHT, a Huntington Station, NY-based certified hand therapist. "Occupational health nurses may not consider the conservative treatments that my colleagues and I use effectively on a daily basis," she says. "Splinting helps, in conjunction with anti-inflammatory treatment and patient education, regarding proper posturing."

Kassimir says the best treatment for an individual depends on many factors: an individual's anatomy, the hand and wrist posture for tasks such as typing or grasping objects, severity and duration of symptoms, and willingness to follow a home exercise and splinting programs.

"Carpal tunnel syndrome is a common diagnosis, but no one treatment is right for everyone," she says. "Each case is different and needs to be evaluated thoroughly to determine the right course of treatment."

Reference

1. Ly-Pen D, Andreu JL, Millan I. Long-term outcome of local corticosteroid injection vs. surgery in carpal tunnel syndrome: An observational extension of a randomized clinical trial. Presented at the American College of Rheumatology Annual Scientific Meeting. Boston; November 2007.