eMedicine Specialties > Clinical Procedures > Anesthetic and Analgesic Techniques

Steroid Injection, Carpal Tunnel

Author: Arie Gluzman, BS, MD, Staff Physician, Physical Medicine & Rehabilitation, UCLA/Greater Los Angeles Veterans Administration
Contributor Information and Disclosures

Updated: Apr 9, 2008

Introduction

Median nerve corticosteroid (steroid) injection at the wrist is used to treat the symptoms of carpal tunnel syndrome by injecting a steroid solution into the ulnar bursa surrounding the median nerve. This procedure is also commonly called a carpal tunnel injection. This injection can be used when conservative measures such as physical therapy, ergonomic modifications, rest, regular exercise, splinting, and nonsteroidal antiinflammatory drug (NSAID) therapies have proved ineffective at relieving symptoms.1,2,3,4

Electrodiagnostic studies such as nerve conduction studies and electromyography are typically obtained to determine the severity of nerve damage prior to performing the procedure.5 Steroid injections should be avoided prior to planned electrodiagnostic testing, as the presence of steroids may alter test results.

Historically, median nerve steroid injections were typically used for only mild median nerve entrapment (as documented by electroneurography) as well as for temporary pain relief in anticipation of definitive flexor retinaculum surgical release. Recent research indicates that local median nerve steroid injections may be more effective than surgical intervention in providing symptom relief over the short term.6,7 The use of anesthetics in conjunction with steroids offers diagnostic information as well as temporary relief.

For a more thorough discussion on pain control, see the Medscape Pharmacologic Management of Pain Resource Center.

Indications

  • Carpal tunnel syndrome not relieved by conservative measures
  • Electrodiagnostic changes consistent with mild-to-moderate median nerve entrapment

Contraindications

  • Adverse reaction to injectable steroid or anesthetic
  • Uncontrolled diabetes mellitus
  • Active systemic or local infection
  • Compromised skin integrity over the area
  • Immunosuppression

More on Steroid Injection, Carpal Tunnel

Overview: Steroid Injection, Carpal Tunnel
Treatment & Medication: Steroid Injection, Carpal Tunnel
Multimedia: Steroid Injection, Carpal Tunnel
References
Further Reading
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References

  1. Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev. Apr 18 2007;CD001554. [Medline].

  2. Aroori S, Spence RA. Carpal tunnel syndrome. Ulster Med J. Jan 2008;77(1):6-17. [Medline].

  3. Piazzini DB, Aprile I, Ferrara PE, Bertolini C, Tonali P, Maggi L, et al. A systematic review of conservative treatment of carpal tunnel syndrome. Clin Rehabil. Apr 2007;21(4):299-314. [Medline].

  4. Bland JD. Treatment of carpal tunnel syndrome. Muscle Nerve. Aug 2007;36(2):167-71. [Medline].

  5. Jarvik JG, Yuen E, Kliot M. Diagnosis of carpal tunnel syndrome: electrodiagnostic and MR imaging evaluation. Neuroimaging Clin N Am. Feb 2004;14(1):93-102, viii. [Medline].

  6. Ly-Pen D, Andreu JL, de Blas G, Sanchez-Olaso A, Millan I. Surgical decompression versus local steroid injection in carpal tunnel syndrome: a one-year, prospective, randomized, open, controlled clinical trial. Arthritis Rheum. Feb 2005;52(2):612-9. [Medline].

  7. Nonsurgical treatment is effective for carpal tunnel syndrome. J Fam Pract. Sep 2004;53(9):685. [Medline].

  8. Sebastin SJ, Puhaindran ME, Lim AY, Lim IJ, Bee WH. The prevalence of absence of the palmaris longus--a study in a Chinese population and a review of the literature. J Hand Surg [Br]. Oct 2005;30(5):525-7. [Medline].

  9. Linskey ME, Segal R. Median nerve injury from local steroid injection in carpal tunnel syndrome. Neurosurgery. Mar 1990;26(3):512-5. [Medline].

  10. Hennink S, van der Horst CM, Breugem CC. Complications following steroid treatment for carpal tunnel syndrome. J Hand Surg Eur Vol. Jun 2007;32(3):362-3. [Medline].

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Further Reading

eMedicine from WebMD: Physical Medicine and Rehabilitation Journal 

American Family Physician: Diagnostic and Therapeutic Injection of the Wrist and Hand Region

Family Practice Notebook: Procedure Chapter

Wheeless’ Textbook of Orthopaedics: Carpal Tunnel Injection/Median Nerve Block

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Keywords

carpal tunnel injection, carpal, carpal tunnel, carpal tunnel syndrome, carpel tunnel syndrome, carpal syndrome, CTS, steroid injection, median nerve block, wrist steroid injection, CTS steroid injection, palmaris longus tendon, flexor carpi radialis tendon, median nerve steroid injection, nerve conduction study, electromyography, flexor retinaculum

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Contributor Information and Disclosures

Author

Arie Gluzman, BS, MD, Staff Physician, Physical Medicine & Rehabilitation, UCLA/Greater Los Angeles Veterans Administration
Disclosure: Nothing to disclose.

Medical Editor

Luis M Lovato, MD, Assistant Clinical Professor, David Geffen School of Medicine at UCLA; Director of Critical Care, Department of Emergency Medicine, Olive View/UCLA Medical Center
Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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