Experiences with Carpal Tunnel Syndrome and Cortisone Injection

A cortisone injection may be used to reduce the swelling in the carpal canal and thereby reducing the pressure on the median nerve that causes the acute symtpoms of carpal tunnel syndrome. IN early mild cases, the injection alone when combined with splinting may be enough to reverse the disease and "cure" the carpal tunnel of its disease. In more moderate to severe cases symptoms may be reduced or erased but recurrent symptoms may occur. A ressponse to an injection however is a favorable sign for eventual success of surgery if surgery is offered at a later date. Failure of an injection to work does not mean that surgery is not indicated but success of an injection is another positive factor associated with a better outcome for surgery. For some a cortisone injection is pallitive atbest but "buys one time" so that pain and numbness is reduced in anticipation of surgery at a later date. Injections oare just one of the arms of treatment for carpal tunnel and like spliintng, NSAIDs or surgery should not be thought of as the only way to treat carpal tunnel symptoms. There is no one treament algorithm that applies to everyone.

Let me add that even with injection I often prescribe a splint to be worn at night and the biggest mistake I seeis that when someone feel better from an injection, they abandon their splint causing the wrist to flex at night and adding again to the irritation in the carpal canal. The best non-surgical, non-drug treatment for carpal tunnel syndrome is a wrist splint. This is especially true for early mild carpal tunnel syndrome with occasional activity related symptoms and night time or nocturnal tingling. By keeping the wrist in a neutral position the median nerve has less pressure placed upon it from the surrounding tissues. It is pressure that exceeds the normal capillary pressure within the nerve itself that forces blood out of the nerve and leads to the changes in the nerve that are seen in carpal tunnel. In early carpal it is just a transient temporary loss of blood to the nerve. This is why when one wakes up with numb fingers form carpal tunnel that hanging hands down or shaking works, it forces the blood back into the nerve.

When we sleep, the fluid in our body that spends the day finding it way into our feet ( that may feel tired and swollen) at the end of the day now redistributes itself when we lie down. At night when we also flex our wrists or extend our wrists into awkward positions it also puts pressure on the nerve. The extra swelling in the nerve and the position can often be lessened by using a simple night time wrist splint. Only a small increase in pressure is needed to push the blood out of the median nerve. Think about when you push on your own palm or fingertip skin and it goes flat or changes color, that's al it takes. Now imagine you put pressure on that same spot every night for a few hours and that area was also subject to increased pressure form local swelling.

SO an injection and a night splint are synergistic

The injection was very painful as it was given directly into my wrists to relieve the median nerve. I could feel it shoot down my my middle finger, my index finger and my thumb. My hands/wrists hurt for a week and the shot has only reduced the pain of my carpal tunnel by maybe 30%. Hope this helps anyone who thinks about getting the shots, as for me I don't think the pain of the injection is worth what you get in exchange.