From the Guidelines
Oral prednisolone is not recommended as a first-line treatment for carpal tunnel syndrome due to its limited long-term benefits and potential side effects. The most recent and highest quality study, a 2021 umbrella review of level 1 evidence published in the BMJ 1, found that surgical treatment was shown to relieve symptoms significantly better than non-surgical treatment, including oral corticosteroids. While oral prednisolone may provide short-term relief, its benefits generally last only 2-4 weeks after treatment ends.
For immediate symptom management, conservative approaches like:
- Wrist splinting (especially at night)
- Activity modification
- Over-the-counter anti-inflammatory medications like ibuprofen are preferred initial steps. Prednisolone works by reducing inflammation around the median nerve in the carpal tunnel, temporarily decreasing pressure and alleviating symptoms like pain, numbness, and tingling. However, oral steroids carry significant side effect risks including:
- Elevated blood sugar
- Mood changes
- Sleep disturbances
- Stomach irritation making them unsuitable for long-term use.
The 2018 American Society of Clinical Oncology clinical practice guideline 1 provides guidance on the management of immune-related adverse events, but it is not directly applicable to the treatment of carpal tunnel syndrome. For persistent symptoms, local corticosteroid injections directly into the carpal tunnel are more effective than oral steroids, while surgical release remains the definitive treatment for severe or persistent cases not responding to conservative measures.
From the Research
Effectiveness of Oral Prednisolone in Carpal Tunnel Syndrome
- Oral prednisolone has been shown to be effective in the short-term management of carpal tunnel syndrome (CTS) 2.
- A study published in 1995 found that low-dose, short-term oral prednisone resulted in significant improvement in global symptom scores, with the effect being rapid but gradually waning over 8 weeks of observation 2.
- Another study published in 2002 found that a two-week and a four-week course of oral steroids were effective in the conservative treatment of CTS, with improvement in symptoms achieved in 66.0% of patients after one month and in 49.0% at the end of the study 3.
- The use of oral steroids in the treatment of CTS is also mentioned in a review of literature published in 2020, which highlights the importance of conservative treatment options, including medications, in the management of CTS 4.
- However, it is worth noting that the long-term efficacy of oral prednisolone in CTS is not well established, and other treatment options, such as physical therapy and neuromobilization, may also be effective in improving symptoms and functional status 5.
Comparison with Other Treatment Options
- Oral prednisolone is just one of several treatment options available for CTS, and its effectiveness should be compared with other options, such as local corticosteroid injection, physical therapy, and surgical decompression 6.
- A study published in 2016 found that local corticosteroid injection can provide relief for more than one month and delay the need for surgery at one year, highlighting the importance of considering alternative treatment options 6.
- Another study published in 2022 found that the addition of neuromobilization to a rehabilitation program for CTS resulted in better treatment outcomes, including improved range of motion, decreased pain, and improved functional status 5.