Caution should be exercised when considering corticosteroid injection in the treatment of carpal tunnel syndrome.

In the treatment of Carpal Tunnel Syndrome, Corticoid injection can help rapidly relieve symptoms in appropriately selected cases. However, this is not a method applicable to all patients and should not be overused. The most important factor is to accurately identify the cause of median nerve compression and select a treatment modality appropriate for each stage of the disease.

1. Accurate diagnosis of the etiology before deciding on Corticoid injection

Not all cases of Carpal Tunnel Syndrome are indicated for corticoid injection. This method is usually suitable only when median nerve compression stems from tenosynovitis or swelling of the flexor tendon synovium, which narrows the carpal tunnel space and exerts passive compression on the nerve.

Conversely, if the cause is congenital carpal tunnel stenosis, fibrosis, or degeneration in the elderly, while internal structures such as tendons and nerves remain normal, corticoid injection typically does not yield long-term efficacy. In these instances, median nerve release surgery is generally the more appropriate choice.

2. Selection of treatment modalities according to disease severity

One common pitfall is providing treatment that is disproportionate to the degree of nerve injury.

• Mild stage: Patients may be monitored, advised on lifestyle modifications, and prescribed neurotropic medications as directed by the physician. Corticoid injection is not necessary for every case from the outset.
• Moderate and severe stages: When the median nerve has suffered prolonged compression, decompression surgery should be considered early. Persisting with conservative management or repeated injections after the disease has advanced may lead to missing the "golden window" for nerve release, thereby impacting future recovery potential.

Timely surgery can help patients recover more rapidly

3. Caution with Corticoid injections

Corticoid injections can provide prompt pain and numbness relief, but this technique demands high precision.

• Never inject directly into tendons or nerves. Inadvertent intratendinous injection increases the risk of tendon rupture, while intraneural injection can cause nerve damage with long-term consequences.
• Prioritize execution under ultrasound guidance. The use of ultrasound aids in accurately pinpointing the injection site, enhancing both safety and efficacy.
• Avoid overuse and repeated injections. If the initial injection alleviates symptoms but the condition subsequently recurs, the administration of a second or third injection requires meticulous consideration. Repeated corticoid injections can lead to synovial hyperplasia, causing abnormal tissue thickening. Once this condition develops, the medication typically becomes ineffective, and subsequent surgical dissection becomes considerably more difficult and complex.

4. Do not overlook systemic complications of Corticoids

Alongside localized risks, systemic use or prolonged overuse of Corticoids can affect the entire body.

Frequent complications include hypertension, diabetes, exacerbation of glycemic control in pre-existing diabetic patients, adrenal suppression, and various other sequelae affecting overall health.

Corticoid injection can be an effective treatment option in appropriately indicated cases. Nevertheless, the priority is not injecting as early or as frequently as possible, but rather precisely identifying the compression etiology and accurately evaluating the severity of median nerve injury.

Patients should be evaluated by a specialist to determine the appropriate treatment strategy, avoiding corticoid overuse or delaying surgery when indicated, thereby minimizing complications and optimizing long-term therapeutic outcomes.