Steroid Injections, When to Operate and Clinical Takeaways

Injection suits mild to moderate cases, improving symptoms and function for three to six months and reducing the need for surgery for up to 12 months. Around 80% respond, usually by three months, but about half relapse within a year. Surgery should wait roughly 8 to 12 weeks after an injection because of infection risk and effects on collagen, so the choice between the two must be planned. Ian questions American Academy of Orthopaedic Surgeons recommendations that rate splinting and injection as strong but give hand therapy none, and agrees oral medication, ultrasound and acupuncture have little support. Surgery is more effective for persistent and severe cases but carries about twice the complications. Normal electrophysiology predicts poorer surgical outcomes and axonal loss lowers the prognosis, so timing matters. In bilateral cases the non-dominant hand recovers faster. His takeaways: plan around the person, use objective markers such as grip dynamometry, and make education central, covering body mass index and workload. Some cases resolve on their own and some worsen, so track progress and seek a second opinion for persistent severe symptoms.