Carpal tunnel syndrome is a widespread condition in society today thanks to the keyboard- and device-driven world we live in. However, over time, as conservative measures and ergonomic adjustments fail to provide relief, many patients with carpal tunnel syndrome turn to steroid injections, a very common treatment for a very common condition. But are steroids a good idea, and do they really work?
What Is Carpal Tunnel Syndrome?
Carpal tunnel syndrome involves compression of the median nerve where it runs through a narrow passage on the palm-side of the wrist. The median nerve actually starts all the way up in the cervical spine (the neck area of the spine), branches down through the length of the arm and terminates in branches at the thumb and most of the fingers. So when carpal tunnel occurs, every structure the median nerve supplies below the compressed nerve can suffer, which is most of the hand and fingers.
What might compress the median nerve? It could be a physical external force, which is why those repetitive keyboard motions that keep this area of the wrist firmly planted on a hard surface for long periods of time can, over time, compress this vulnerable nerve. One study even suggested a link between carpal tunnel syndrome and Smartphone overuse. In addition, there could also be a nerve condition within the body itself that could cause this to occur. Symptoms of carpal tunnel syndrome could be anything from pain, swelling, and numbness to tingling or even a pins-and-needles feeling in the wrist, thumb, or the first three fingers (the pinkie and part of the ring finger is supplied by a different nerve—the ulna nerve).
Many patients with carpal tunnel syndrome will turn to steroids, many times as an attempt to delay what they believe is the inevitable surgery. One study, however, shows the steroids may be sabotaging your surgical results. Let’s take a look.
Carpal Tunnel Steroid Injections Mean Poor Surgical Outcomes
One study compared the five- to six-year outcomes following carpal tunnel surgery in patients who’d had steroid injections to those who hadn’t. They found poorer long-term outcomes (e.g., continuing pain and tingling, waking at night in discomfort, etc.) in those who’d had steroid injections before they had surgery than in those who didn’t have steroid injections before surgery. And, interestingly, the more injections received, the higher these risks. In addition, only slightly over half (53%) of patients who received steroid injections reported full resolution of their symptoms five and six years after their surgery.
So does this mean you should just skip the steroids from the start and go straight for the carpal tunnel surgery? No way! As we’ve covered before, surgery is also bad news for carpal tunnel syndrome as it is an invasive procedure that involves cutting a crucial ligament, which disrupts the biomechanics in the wrist.
More Problems Linked to Steroid Injections
Steroid injections, regardless of what condition they are treating, are associated with so many problems. You might be relieving your inflammation and pain (though not always as you’ll read below), but you may be setting yourself up for many more problems in the future. Let’s take a look at a few problems with steroids:
- Steroids wipe out mesenchymal stem cells.
- Steroids damage tendon cells and worsen tendinitis symptoms.
- Steroids kill cartilage!
- Steroids disrupt your hormones that manage stress (i.e., the cortisol pituitary axis)
So if surgery is bad and steroids are bad, what’s the alternative?…
Treating Carpal Tunnel Syndrome Nonsurgically with Your Own Platelet Lysate
Your own platelets can be isolated and their growth factors concentrated. This platelet lysate can then be injected under precise imaging guidance around the compressed median nerve. Take a look at the video below as Dr. Centeno performs this hydrodissection procedure for carpal tunnel syndrome:
Steroid injections are not the answer for carpal tunnel syndrome. If the intention is to delay surgery, it appears that all of those steroid injections will just decrease your risk for a successful surgery. So if you must go the surgical route, you certainly don’t want to sabotage your outcomes. That being said, surgery, too, is a bad idea for carpal tunnel syndrome as well as it disrupts the biomechanics in the wrist that can only create more problems in the future. Your interventional orthopedic physician, on the other hand, can treat your carpal tunnel nonsurgically and without harmful steroids by utilizing your own platelets.