The comparison between effectiveness of ultrasound-guided corticosteroid injection above versus below the median nerve in mild to moderate carpal tunnel syndrome

Abstract Carpal tunnel syndrome (CTS) refers to the symptoms and signs caused by the compression of the median nerve in the carpal tunnel. It can be treated by corticosteroid injection into the carpal tunnel. Two methods for injection have been employed, namely ultrasound-guided and landmark-guided injection. This systematic review and meta-analysis was conducted to compare these methods in terms of several outcomes. Randomized controlled trials (RCTs) were identified, and data collection was completed on 7 October 7, 2020. Results for continuous variables are expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Analyses were performed using RevMan 5.3 software. The analysis included eight RCTs published between 2013 and 2019 with a total of 448 patients. Ultrasound-guided injection yielded more favorable results for the Boston Carpal Tunnel Syndrome Questionnaire, Symptom Severity Scale [SMD = −0.49, 95% CI (−0.74, −0.25), P < 0.0001], Boston Carpal Tunnel Syndrome Questionnaire, Functional Status Scale [SMD = −0.24, 95% CI (−0.42, −0.06), P = 0.01], distal motor latency [SMD = −0.36, 95% CI (−0.70, −0.02), P = 0.04], and compound muscle action potential [SMD = 0.38, 95% CI (0.16, 0.61), P = 0.0008] . Ultrasound-guided corticosteroid injection is recommended for patients with CTS.

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Volume Matters in Ultrasound-Guided Perineural Dextrose Injection for Carpal Tunnel Syndrome: A Randomized, Double-Blinded, Three-Arm Trial

Frontiers in Pharmacology ◽

10.3389/fphar.2020.625830 ◽

2020 ◽

Vol 11 ◽

Author(s):

Meng-Ting Lin ◽

Chun-Li Liao ◽

Ming-Yen Hsiao ◽

Hsueh-Wen Hsueh ◽

Chi-Chao Chao ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Group Analysis ◽

Post Injection ◽

Ultrasound Guided ◽

Electrophysiological Studies ◽

Tunnel Syndrome ◽

Double Blinded

Ultrasound-guided perineural dextrose injection (PDI) has been reported effective for carpal tunnel syndrome (CTS). Higher volume of injectate may reduce adhesion of median nerve from other tissues, but volume-dependent effects of PDI in CTS remain unknown. We aimed to investigate whether PDI with different injectate volumes had different effects for CTS participants. In this randomized, double-blinded, three-arm trial, 63 wrists diagnosed with CTS were randomized into three groups that received ultrasound-guided PDI with either 1, 2 or 4 ml of 5% dextrose water. All participants finished this study. Primary outcome as visual analog scale (VAS) and secondary outcomes including Boston Carpal Tunnel Questionnaire (BCTQ), Disability of the Arm, Shoulder and Hand score (QuickDASH), electrophysiological studies and cross-sectional area (CSA) of the median nerve at carpal tunnel inlet were assessed before and after PDI at the 1st, 4th, 12th and 24th weeks. For within-group analysis, all three groups (21 participants, each) revealed significant improvement from baseline in VAS, BCTQ and QuickDASH at the 1st, 4th, 12th and 24th weeks. For between-group analysis, 4 ml-group yielded better VAS reduction at the 4th and 12th weeks as well as improvement of BCTQ and QuickDASH at the 1st, 4th, and 12th weeks, compared to other groups. No significant between-group differences were observed in electrophysiological studies or median nerve CSA at any follow-up time points. There were no severe complications in this trial, and transient minor adverse effects occurred equally in the three groups. In conclusion, ultrasound-guided PDI with 4 ml of 5% dextrose provided better efficacy than with 1 and 2 ml based on symptom relief and functional improvement for CTS at the 1st, 4th, and 12th week post-injection, with no reports of severe adverse effects. There was no significant difference between the three groups at the 24th-week post-injection follow-up.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03598322.

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Re: Median nerve damage following local corticosteroid injection for the symptomatic relief of carpal tunnel syndrome

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934097318 ◽

2009 ◽

Vol 34 (1) ◽

pp. 135-136 ◽

Cited By ~ 7

Author(s):

Marc C. Swan ◽

Kerstin Oestreich

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Corticosteroid Injection ◽

Symptomatic Relief ◽

Nerve Damage ◽

Tunnel Syndrome ◽

Local Corticosteroid Injection

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Ultrasound-guided vs. landmark-guided local corticosteroid injection for carpal tunnel syndrome: A systematic review and meta-analysis

Annals of Physical and Rehabilitation Medicine ◽

10.1016/j.rehab.2018.05.308 ◽

2018 ◽

Vol 61 ◽

pp. e138-e139

Author(s):

A. Babaei-Ghazani ◽

P. Roomizadeh ◽

A. Shirin

Keyword(s):

Systematic Review ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Corticosteroid Injection ◽

Meta Analysis ◽

Ultrasound Guided ◽

Tunnel Syndrome ◽

Local Corticosteroid Injection

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Median Nerve Injury in Ultrasound-Guided Hydrodissection and Corticosteroid Injections for Carpal Tunnel Syndrome

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-1140-5717 ◽

2020 ◽

Author(s):

Yi-Chih Hsu ◽

Fu-Chi Yang ◽

Hsian-He Hsu ◽

Guo-Shu Huang

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Clinical Data ◽

Vascular Injury ◽

Carpal Tunnel ◽

Corticosteroid Injection ◽

Tunnel Syndrome ◽

Flattening Ratio ◽

Median Nerve Injury ◽

Corticosteroid Injections

Abstract Purpose Permanent nerve damage after corticosteroid injection has been suggested when symptoms of median nerve injury (MNI) are irreversible. We assess the outcomes of MNI and their association with ultrasonography (US)-guided hydrodissection and the following corticosteroid injection for symptomatic carpal tunnel syndrome (CTS). Methods US-guided hydrodissection and the following corticosteroid injections were administered to 126 CTS patients. Occurrence of MNI, clinical data, and post-hydrodissection findings were evaluated. Post-hydrodissection findings included vascular injury during hydrodissection, altered echogenicity, reduced flattening ratio, and increased cross-sectional area of the MN at the inlet of the carpal tunnel (MN-CSA-Inlet) on ultrasonography after hydrodissection. The relevance of MNI with respect to these clinical data and findings was determined. The outcome was rated using Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scores. Results Nine patients suffered MNI (incidence, 7.1 %) but improved significantly at follow-up. Clinical data and vascular injury during hydrodissection, altered echogenicity, and reduced flattening ratio after hydrodissection were unrelated to prolonged transient MNI (p > 0.05). MNI was significantly associated with increased CSA (p = 0.005). A CSA increase > 2 mm2 after hydrodissection yielded the greatest performance (0.979) for MNI in the receiver operating characteristic analysis. Decreases in BCTQ scores after injection did not differ significantly between groups with and without MNI (p > 0.05). Conclusion MNI during hydrodissection may be reversible. MNI is indicated by an increase in MN-CSA-inlet immediately after hydrodissection.

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