Corticosteroid Injection Versus Surgical Decompression in Carpal Tunnel Syndrome: A Prospective Comparative Interventional Study Using Clinical, Electrophysiological, and Sonographic Outcomes

Background: Carpal tunnel syndrome (CTS) is one of the most common compressive neuropathies. Corticosteroid injection is a pharmacological treatment modality, whereas carpal tunnel release is a surgical treatment option for the management of CTS. Conservative non-pharmacological interventions include wrist splinting, therapeutic exercises, activity modification, ergonomic measures, occupational therapy, and physical therapy. However, the comparative efficacy of corticosteroid injection and surgical decompression remains controversial, particularly when evaluated using objective outcome measures. The present study compared pain relief and median nerve (MN) dynamic mobility following corticosteroid injection and carpal tunnel release in patients with CTS. Methods: This prospective comparative interventional study included 60 patients with CTS refractory to conservative therapy. Patients were allocated to two groups by alternate consecutive assignment: surgical decompression (Group A, n = 30) and corticosteroid injection (Group B, n = 30). As this was a prospective comparative interventional study, randomization was not performed. Outcomes were assessed using the Visual Analog Scale (VAS), the Boston Carpal Tunnel Questionnaire (BCTQ), ultrasonographic parameters, and nerve conduction studies over a six-month follow-up period (post-procedure, one week, one month, three months, and six months). MN mobility, cross-sectional area (CSA), nerve conduction velocity, and median distal motor latency were also evaluated. Data were analyzed using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, NY, USA). Results: Both groups demonstrated significant improvements in pain and symptom severity. No significant differences were observed between the groups in VAS pain scores or BCTQ Symptom Severity Scale (BCTQ-SSS) scores. At baseline, Group A had mean VAS scores for pain, neuroparesthesia, and functional impairment of 6.43 ± 0.97, 4.43 ± 1.76, and 4.40 ± 1.71, respectively, compared with 5.97 ± 0.93, 4.90 ± 1.65, and 3.63 ± 1.25 in Group B. At six months, these scores decreased to 1.93 ± 0.87, 1.17 ± 0.38, and 1.13 ± 0.35 in Group A and to 1.87 ± 0.68, 1.77 ± 0.97, and 2.27 ± 1.17 in Group B. Mean BCTQ symptom severity scores decreased from 45.03 ± 4.73 to 11.30 ± 2.37 in Group A and from 43.20 ± 6.03 to 11.53 ± 2.15 in Group B. Functional outcomes were significantly better in the surgical group. MN mobility improved significantly following surgery compared with corticosteroid injection. Comparison of MN parameters immediately after the procedure and at six months showed no significant differences between the groups except for MN mobility, which was greater in Group A than in Group B (14.51 ± 1.49 vs. 13.62 ± 0.98; p = 0.008). No significant between-group differences were observed in electrophysiological parameters. Conclusion: Both treatment modalities were effective in improving symptoms of CTS. However, surgical decompression provided superior functional recovery and greater improvement in MN mobility than corticosteroid injection.