A 15-minute steroid-free treatment beat steroid shots for carpal tunnel relief in a 63-patient trial

A procedure that took about 15 minutes and used no steroid gave people with stubborn carpal tunnel syndrome longer-lasting relief than a steroid injection in a randomized trial of 63 patients. Anindita Bose, a radiologist in Jaipur, India, led the work, which was published in the journal Radiology.

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The technique, called ultrasound-guided hydrodissection, injects fluid around the median nerve at the wrist under ultrasound guidance, with the aim of freeing the nerve from the tissue pressing on it. In the steroid-free version tested, that fluid was plain saline, so the relief cannot be credited to a drug. Carpal tunnel syndrome is the nerve-compression condition behind numb, tingling hands, and patients whose symptoms persist after conventional care are often steered toward surgery, and the ScienceDaily summary frames the 15-minute treatment as something that could help patients avoid that surgery.

Three arms, 63 patients, and a six-month window

The prospective randomized controlled trial of hydrodissection for carpal tunnel syndrome appeared in Radiology, the journal of the Radiological Society of North America. Bose is an assistant professor of radiology at Mahatma Gandhi Medical College and Hospital in Jaipur, and Anupama Tandon, a professor of radiodiagnosis and imaging at University College of Medical Sciences and Guru Teg Bahadur Hospital in Delhi, is a co-author. The RSNA announcement says all 63 participants had confirmed carpal tunnel syndrome that had not responded to conventional treatment.

They were split into three equal groups. One received ultrasound-guided hydrodissection with normal saline alone, a second received hydrodissection with saline plus a corticosteroid, and the third received an ultrasound-guided corticosteroid injection alone. Symptom scores, hand function, pain scores and the cross-sectional area of the median nerve on ultrasound were checked at 4, 12 and 24 weeks, which the release also describes as a six-month follow-up.

Relief that lasted versus relief that faded

At four weeks every group had improved significantly, so the early picture did not separate the treatments. The difference appeared later. According to the ScienceDaily version of the RSNA release, both hydrodissection groups kept improving in symptoms and hand function at 12 weeks and six months, while the symptoms of those who got the steroid injection alone returned during follow-up. Adding a corticosteroid to the hydrodissection fluid brought no statistically significant extra long-term benefit over saline by itself, which is why the comparison between saline-only hydrodissection and a steroid shot carries the most weight. Put simply, the steroid inside the fluid added nothing that the researchers could measure in this trial, and the steroid-free procedure matched or beat the alternatives at every point after the first month.

The ultrasound measurements pointed the same way. Median nerve cross-sectional area shrank by about 43% to 45% after hydrodissection, compared with about 15% after the steroid injection alone. No significant complications were observed, either right after treatment or during follow-up.

Tandon said that traditional steroid injection for carpal tunnel syndrome often provides only temporary relief, and described hydrodissection as a safe, minimally invasive treatment that can provide sustained clinical and morphological improvement. In a Applied Radiology account of the release, she added that many patients had suffered for extended periods despite various treatments, and noted that corticosteroids carry risks including local skin changes, thinning of fat and weakening of tendons.

Limits of a small trial from India

The practical details are part of the appeal. The procedure needed no anesthesia or hospital stay, was described as inexpensive, and left patients able to return to work within an hour. Those are the authors’ descriptions of their own trial, and the release gives no cost figures.

The size and length of the study set clear boundaries. Sixty-three participants is a small sample, six months of monitoring cannot confirm how long the benefit lasts, and the authors themselves call for larger, multicenter studies with longer follow-up. An earlier version of the work presented at the 2022 RSNA annual meeting, summarized by HealthDay, counted the 63 as wrists rather than patients and reported nerve-area reductions at 12 weeks of 43% and 46% for the two hydrodissection groups versus 11% for steroid alone, which differ somewhat from the published figures.

The participants were also a specific group: people whose symptoms had persisted despite conventional treatment, not everyone who develops numb or tingling hands. The finding therefore says nothing about people newly diagnosed, or about those who already need surgery. Tandon said the team is running a follow-up study comparing saline with dextrose as the hydrodissection fluid, so the question of which fluid works best is still being tested.

For now, the evidence is a single randomized comparison with one steroid-free arm. It supports the idea that freeing the nerve with fluid can outlast a steroid shot in this population, while leaving open how it compares with surgery, splinting or other injections, none of which were arms of the trial. Anyone weighing treatment for persistent carpal tunnel symptoms would still be deciding with a hand surgeon or neurologist, and a single six-month randomized trial of 63 patients is a starting point for that conversation rather than a replacement for it.

This article was produced with the assistance of AI and reviewed by Morning Overview editors prior to publication.

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