Corticosteroids for carpal tunnel syndrome

Examples

Generic Name	Brand Name
prednisolone
prednisone	Winpred
triamcinolone	Aristospan, Kenalog

Although corticosteroids are available in oral (tablets or syrup) form, injections (shots) are most commonly used for treating carpal tunnel syndrome.

How It Works

Corticosteroids relieve inflammation.

Why It Is Used

Corticosteroids are given to relieve inflammation due to carpal tunnel syndrome when other forms of treatment (such as rest, using a wrist splint, or using anti-inflammatories) have not helped relieve pain.

When it should not be used (contraindications)

Some health professionals believe that corticosteroids should not be given to children, nor to women who are pregnant or breast-feeding.

If infection is suspected, injections are usually not given.

How Well It Works

Short-term oral corticosteroid treatment (for 2, 4, and 8 weeks) has been shown to significantly reduce carpal tunnel syndrome symptoms.¹ It is not clear how long the effect of the oral corticosteroids lasts.

Corticosteroid injections have been shown to significantly reduce carpal tunnel symptoms, as measured 4 to 6 weeks after injection.¹ However, although they often provide temporary relief (for several weeks or more), they do not typically provide permanent relief from carpal tunnel symptoms.

If three injections over several months have not helped to relieve pain, more injections are not likely to help and may cause harm. Even if the injections help to relieve pain, the number of injections should be limited. Talk to your health professional about corticosteroid injections.

Side Effects

Corticosteroids (oral or injections) have serious side effects and must be used with caution. Side effects include:¹

• Nausea.
• Anxiety.
• Acne.
• Menstrual irregularities.
• Insomnia.
• Headaches.
• Mood swings.

Although they may relieve pain and inflammation, corticosteroids can also slow healing and weaken tendons and bones (osteopenia or osteoporosis). Other side effects of corticosteroid injection include:

• Pain that gets worse after the injection. Applying ice at home for 15 to 20 minutes after the injection may help reduce pain.
• Loss of strength and movement in the tendon.
• Breakdown (degeneration), tearing, or rupture of the tendon.
• Accidental injury to the median nerve in the wrist during injection.
• Scarring of the tendon.
• Skin colour (pigmentation) changes at or near the injection site.
• Infection.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Other forms of treatment to relieve pain and inflammation (such as rest, ice, non-steroidal anti-inflammatories, splints, and exercises) are usually tried before corticosteroids are used.

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Author:	Douglas Dana Monica Rhodes	Last Updated: January 11, 2007
Medical Review:	William M. Green, MD - Emergency Medicine Adam Husney, MD - Family Medicine David Pichora, MD, FRCSC - Orthopedic Surgery
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