Steriod injection while waiting for surgery

We have done this combination of steroid injection while waiting for a surgery appointment to come round a few times and in one or two cases it has presented us with the interesting dilemma of whether to go ahead with surgery in a patient who has become asymptomatic after injection. It hasn't happened enough that we have arrived at a firm policy and I would judge each case individually I think. I would be more inclined to go ahead with surgery if the original CTS was severe and if uncertain I might even repeat the nerve conduction studies just to check whether it really was dramatically better. We undoubtedly would inject both hands where both are significantly symptomatic, and a decision on surgery for the second hand would always be deferred until we had a feeling for what changes had occurred in both sides after the first operation. It is not unknown for the CTS in second hand to resolve when the first is operated - don't ask me how or why this happens but it does occasionally. 

I am not clear what you would recommend in my case and I am not sure what to do now! My grading was approx 3 in both hands and I don't know how severe you would consider that to be.As I said, it would be nice to have some relief from the symptoms but I would rather that was permanent - would you go ahead with the booked surgery if I had had injections and found them still effective at the booked surgery date?

I think it's hard to prejudge the issue but the sort of approach one might take would be to go ahead with surgery if there were ANY residual symptoms at 2 weeks before the operation date - but if the hands were both entirely asymptomatic and 'normal' at that one point one might opt to defer surgery, perhaps repeating the nerve conduction studies to be on the safe side. I am naturally fairly conservative about surgery and tend to avoid it where it is not clearly necessary. I will freely admit that others take a much more active line and it is an area where there is a lot of scope for differences of opinion.

Oh dear, this has made me more confused than ever! When I saw you it seemed to me from our converstion that the injections were more likely to be of a temporary nature with surgery being a more permanent solution (albeit slightly more risky) and suitable for my grade 3s! I therefore decided to go for surgery but now have doubts if that is the correct thing to do.

I sympathise - it is genuinely not a straightforward decision and, as is often the case in medicine, neither course of action has a guaranteed outcome. I do think that the statistics are in favour of surgery for grade 4 and 5 and injection for grade 1 and 2 but for grade 3 it is very finely balanced. When waiting times for surgery are a little longer, as they are at present, it presents an especially tempting opportunity to inject while waiting for surgery and in any case I think most people reason that the risk and inconvenience of injection are so low that they might as well give it a try anyway in this particular circumstance. In more normal times when the waits for injection and surgery are not greatly different then it might be said that the main 'risk' of injection is not actual ill effects from injection, but the possibility that delay might result in the CTS being worse by the time it comes to surgery in the end. In practice this seems to be very rare and I will at some point post some figures here on the site, but when you are having to wait for surgery in any case this objection disappears and giving injection a try in the short term looks like an option with almost no down-side unless you really are phobic about needles.So if you want to know what I would do it would undoubtedly be to inject now but keep the surgery appointment - and then think about it some more. I think this is a particularly useful discussion to have on the forum here as this is a not uncommon dilemma for patients attending the clinic so thankyou for discussing it in public.

Incidentally, your analysis that injections are more likely to be temporary and surgery more likely to be permanent is exactly right, but the two options not only have different chances of long term success (greatly in favour of surgery), but also different chances of serious ill-effects (greatly in favour of injection) and it is balancing these two conflicting tendencies that is so hard.

Thank you for your long & informative reply. I think from what you have said that it would be worth me trying the injections - do you arrange this for me or do I need to do anything else to initiate this process? I have no idea where they could be done (I live in Folkestone). Many thanks for your help.

Just call the SIPC office in Ashford and ask them to arrange an injection for you - the number is in contacts here. They can refer to this discussion themselves to check that it is OK with me (they are having a little trouble accessing the main records system at present - being messed about by the IT department). There are several GPs around who have been trained to do this and they will try to get it done as locally as possible for you.

Thank you. I will let you know how I get on.