Feb 24, 2005

Jennifer Gremmels

Hand Surgeons Respond to CTS Claims in New York Times


Rosemont, Ill. - A recent article by Dr. Domingo Ly-Pen of Madrid reports that, for three months, steroid injection is more effective than surgery in the reduction of carpal tunnel symptoms for patients with mild, new onset disease. However, after the initial success, the effectiveness of injection trends downward and at one year falls below that of surgery. If this study parallels the findings of other investigations, the success rate of injection can be expected to decline further with time while the surgery success rate remains constant or improves.

For a patient with carpal tunnel syndrome, this study raises two questions regarding the potential use of an injection as the primary form of treatment: will my hand respond positively to the injection and, if so, how long will the beneficial effect last. Previous studies, with longer-term follow-up than that provided by Ly-Pen, have shown that patients with mild carpal tunnel syndrome have a long- term positive response rate of less than 50%, whereas patients with more advanced nerve compression (loss of feeling in the fingers, weakness, and symptoms present for more than six months) have a far poorer outcome, with a less than 20% positive response rate long- term. These findings have led to hesitancy among medical providers to offer steroid injection as a potential cure for carpal tunnel syndrome. In contrast, the results of carpal tunnel surgery, as indicated by Ly-Pen's early findings, are stable over time, with 75-85% positive response rates provided long-term.

While there is no accepted treatment algorithm for carpal tunnel syndrome due to the wide variability in presentation, most members of The American Society for Surgery of the Hand utilize injection in patients with mild recent onset disease, who understand that symptoms will recur ultimately in many cases. While injection remains an option for patients with more severe compression, the modest success rate seen at greater than one year, coupled with the risk of permanent nerve damage if nerve compression persists, has led to the recommendation that surgical decompression be considered as primary treatment in these patients.

About Hand Surgeons
Hand surgeons have received specialized additional training in the treatment of hand problems in addition to their board certified specialty training in orthopedic surgery, plastic surgery, or general surgery. To become members of the American Society for Surgery of the Hand, hand surgeons must have completed a full year of such additional training and must pass a rigorous certifying examination. Many hand surgeons also have expertise with problems of the elbow, arm, and shoulder. Some hand surgeons treat only children, some treat only adults, and some treat both. Common problems treated include carpal tunnel syndrome, tennis elbow, wrist pain, sports injuries of the hand and wrist, fractures of the hand, wrist, and forearm, and trigger fingers. Other problems treated by hand surgeons include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects). Not all problems treated by a hand surgeon need surgery. Hand surgeons often recommend non-surgical treatments, such as medication, splints, therapy, and injections. Hand surgeons are specialists devoted to hand care.

About the ASSH
The mission of the American Society for Surgery of the Hand (ASSH) is to advance the science and practice of hand surgery through education, research and advocacy on behalf of patients and practitioners. Founded in 1946, the American Society for Surgery of the Hand is the oldest medical specialty society in the United States devoted entirely to continuing medical education related to hand surgery.