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A total of 178 patients with 202 affected hands were studied prospectively for the management of carpal tunnel syndrome (CTS). Eighty six patients (105 hands) were treated with local steroid injection and 92 patients (97 hands) treated by surgical decompression, the follow up period ranged from 1 to 42 months. The period of relief and the risk of symptoms relapse after each management technique was evaluated. Of the total 86 hands (89%) treated surgically were free of symptoms at the follow up period, only 12 hands (11%) treated by local steroid injection were symptom free after more than one year of follow up. The results showed that local steroid injection have long term effect in the hands with mild symptoms, most were free from daily activity related pain and paresthesia with a duration less than 6 months and with mild median nerve compression in electro diagnostic studies. Surgical release provides better long period of recovery with low rate of relapse, in those hands with severe symptoms and nerve compression that lead to continuous night and daily activity complain, regardless of the duration of symptoms. Introduction arpal tunnel syndrome is a painful disabling condition that causes functional impairment and loss of sleep in the severe cases, several methods of treatment have been suggested and studied, the initial choice is questionable that may be influenced by various factors; such as the severity of the symptoms, its duration, age, occupation, and the electro diagnostic severity 1-4 . Local steroid injection and surgical release are the common methods of treatment in CTS 5,6 . Most of the studies considered that local steroid injection is a less invasive nonsurgical management of CTS but the majority demonstrated a temporary response, rarely permanent relief, followed by high rates of recurrence 7-10 , justified in a certain situations, also it may serve a diagnostic tool to exclude other conditions that mimic CTS, and as a predictor of the response to surgery 3,6,11,12 . It is widely accepted that surgical release of the median nerve is one of the most often performed treatment for CTS with superior outcome to those nonsurgical treatments, most of the patients experienced sustained functional improvement after surgery, with a low recurrence rates 13-15 . The aim of this study is to determine the best initial necessary method of treatment of this syndrome from the identification of the selected factors and the most accurate indications that may be predictive for rapid and the long term response. C Local steroid injection and carpal tunnel syndrome Avadis A Muradian Bas J Surg, March, 13, 2007 Materials and Methods From June 2002 to March 2006, only 178 patients (164 women, 14 men) with CTS could be followed after management, and were included in this present study at Basrah general hospital. The average age of the patients was 42 years ( range from 22 to 60). In 24 patients(13%) both hands were treated giving a total of 202 hands. The duration of symptoms ranged from 2 to 136 months (average 34 months). Diagnosis of the CTS was based on the clinical history especially for the night pain and paresthesia(NPP), and the daily activity related disabilities(DAD), physical examination tests were performed in all, and the electro diagnostic studies were done in 180 hands (89%). The local steroid injection in the carpal tunnel at the distal wrist crease was done in 86 patients(105 wrists). Patients were evaluated for the symptomatic relief obtained and for the relapse although the period was variable; at 2 weeks, 6 weeks, 12 weeks, and some at 6 and 12 months intervals. In 26 wrists more than one local steroid injection was performed. After the assessment of the results, the patients who had severe or worsening of the symptoms during the follow up period were subjected to surgery. Surgical decompression was performed in 92 patients (97 wrists), by the release of transverse carpal ligament through mid palmar curved longitudinal incision. Postoperatively, all the patients were assessed for the quality of satisfaction and rapidity of the improvement from symptoms and for the residual disabilities at 1 week (time of change of the dressing), 2 weeks (time of the sutures removal), 6 weeks, 3 months, and 6 months intervals. All the patients were advised avoiding heavy manual work after operation for at least one month. As usual, only the patients with no improvement or with residual disabilities and those who developed CTS in the other hand return to us during the follow up period. Results In 86 patients (48%) with 105 hands who were treated by local steroid injection the average age was 39 years (range from 22 to 60), with average duration of symptoms 21 months (range 2 to 72) , and the associated conditions shown in Table I . Table I: Associated Conditions in local steroid injection group. Condition No. of Patients

LOCAL STEROID INJECTION OR SURGERY IN THE MANAGEMENT OF CARPAL TUNNEL SYNDROME; THE POSSIBLE PREDICTIVE FACTORS FOR THE CHOICE OF TREATMENT