title: Preoperative corticosteroid injections are associated with worse long-term outcome of surgical carpal tunnel release.
abstract: OBJECTIVE
  Failed closed treatment of carpal tunnel syndrome (CTS) is often followed by surgery. We investigated whether preoperative steroid injections could have a negative effect on the long-term outcome of the operation.
  
  
  METHODS
  174 hands (164 patients) were operated on by a single surgeon at Tartu University Hospital in 2005. The patients were interviewed by telephone 5-6 years after the operation. Self-reported data were gathered retrospectively concerning the number of steroid injections received before the surgery and the perceived regression of symptoms (on a 100-point numeric rating scale) at the time of interview. The patients were also asked about the presence of specific symptoms of CTS if regression of their symptoms had not been complete.
  
  
  RESULTS
  93 of the 174 hands had complete regression of symptoms. Each additional injection was associated with an increased risk of occurrence of pain (RR = 1.1, 95% CI: 1.02-1-2), paresthesiae (RR = 1.1, CI: 1.1-1.2), and nocturnal awakenings (RR = 1.2, CI: 1.1-1.3). There was a weak association between the number of injections and the score given to regression of symptoms.
  
  
  CONCLUSIONS
  This is the first study to indicate that patients who received a greater number of local steroid injections preoperatively were more likely to have postoperative complaints associated with CTS.
authors.affiliation: Faculty of Medicine , Tartu University Hospital, Tartu , Estonia .
authors.forename: Paul-Sander
authors.initials: PS
authors.lastname: Vahi
authors.forename: Mart
authors.initials: M
authors.lastname: Kals
authors.forename: Leho
authors.initials: L
authors.lastname: Kõiv
authors.forename: Mark
authors.initials: M
authors.lastname: Braschinsky
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002349:Carpal Tunnel Syndrome / Q000188:drug therapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000139:chemically induced; D010292:Paresthesia / Q000139:chemically induced; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012893:Sleep Wake Disorders / Q000139:chemically induced; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids