To the Editor: We read with great interest the recent Medicine by the Numbers by Drs. Neubauer and Alisangco on surgical vs nonsurgical treatments for carpal tunnel syndrome.1 We agree with their findings and conclusions about the treatment of carpal tunnel syndrome, with one exception: “… evidence is uncertain about whether surgery vs corticosteroid injection results in beneficial long-term clinical improvement….”1
In 2005, we published a randomized clinical trial comparing local corticosteroid injections vs surgery in treating primary carpal tunnel syndrome (163 wrists).2 Follow-up occurred at 3, 6, and 12 months and 2 and 6 years posttreatment.3,4 At the 6-year follow-up, surgery appeared to be more effective than local corticosteroid injections. The accumulated incidence of therapeutic failure was 11.6% in the surgery group vs 41.8% in the injection group (see figure 1).4 Conversely, 58% of patients in the injection group did not need further therapeutic interventions during the 6-year follow-up period.
We believe that these results definitively support the superiority of surgery to local corticosteroid injections for carpal tunnel syndrome in the long term.
In Reply: We appreciate your response and your 2005 study that demonstrated a lower therapeutic failure rate for surgical decompression (11.6%) compared with local corticosteroid injection (41.8%) at 6 years.1 Notably, 58% of patients in the injection group did not require further intervention during this period, indicating that local corticosteroid injection offers durable benefits for a subset of patients.1 However, our Medicine by the Numbers focuses on the 2024 Cochrane review of 14 randomized trials of surgery compared with multiple nonsurgical interventions, including splinting, corticosteroid injection, platelet-rich plasma, and multimodal conservative care.2,3 The review highlights the uncertainty in direct comparisons between surgery and local corticosteroid injection, including for outcomes longer than 3 months. The review concluded that long-term clinical improvement and symptom relief differences between surgery and local corticosteroid injection remain uncertain.3
