Treatment of carpal tunnel syndrome using many repeated local corticosteroid injections has become a not uncommon mode of treatment in primary care, notwithstanding an existing recommendation that no more than three injections should be given to one wrist (Huisstede 2014). Only one prior study has looked at long-term progression to surgery in patients treated with more than one injection (Jenkins 2012) We studied the clinical outcomes and treatment pathways in a cohort of 254 patients with documented CTS who initially opted for corticosteroid treatment during 2007, until 2015. One hand per patient was studied. Follow-up records of treatment were obtained for 157 patients of whom 65 (41%) had proceeded to surgery by 2015. An average of 1.9 further injections had been given before surgery. In the unoperated group an average of 2 further injections had been given (range 0-12). Final subjective severity and functional status scores were significantly lower in the operated than in the unoperated group (SSS 1.37 vs 1.92 p<0.0001, FSS 1.41 vs 1.81 p<0.01) but both groups improved significantly from baseline and the difference between the final scores is less than the estimated minimal clinically important difference for this measure. As only a minority of patients required surgery over an 8 year period we conclude that repeated steroid injection may be a valid treatment option for some patients with CTS.