Lancet

Surgery bests corticosteroid injection for long-term recovery in carpal tunnel syndrome

July 1, 2025

For patients with carpal tunnel syndrome (CTS), initial surgery provides a significantly higher likelihood of long-term recovery than starting with corticosteroid injection, even when subsequent interventions are allowed.

Study details: The open-label, multicenter, randomized DISTRICTS trial, conducted across 31 Dutch hospitals, enrolled 934 adults with electrophysiologically or sonographically confirmed CTS of at least 6 weeks’ duration. Participants were randomized to initial treatment with either surgery or corticosteroid injection, with additional interventions permitted as needed. Primary outcome was the proportion of patients recovered (score <8 on the 6-item CTS scale) at 18 months, analyzed by intention-to-treat.

Results: At 18 months, 61% of patients in the surgery group had recovered vs. 45% in the injection group (relative risk, 1.36; 95% confidence interval, 1.19–1.56; p<0.0001). Adverse event rates were similar between groups (86% surgery, 85% injection), with only one hospitalization for surgical complications and no treatment-related deaths.

Source:

Palmbergen WAC, et al; Dutch CTS study group. (2025, June 14). Lancet. Surgery versus corticosteroid injection for carpal tunnel syndrome (DISTRICTS): an open-label, multicentre, randomised controlled trial. https://pubmed.ncbi.nlm.nih.gov/40517008/