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

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.

Diffusion tensor imaging findings of the median nerve before and after carpal tunnel corticosteroid injection in patients with carpal tunnel syndrome: a preliminary study

2018 ◽  
Vol 60 (3) ◽  
pp. 347-355
Author(s):  
Yi-Chih Hsu ◽  
Fu-Chi Yang ◽  
Hsian-He Hsu ◽  
Guo-Shu Huang
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Diffusion Tensor ◽  
Corticosteroid Injection ◽  
Symptom Relief ◽  
Bone Level ◽  
Tunnel Syndrome ◽  
Corticosteroid Injections ◽  
Pisiform Bone

Background Corticosteroid injections are a popular technique for carpal tunnel syndrome (CTS) treatment and are believed to provide rapid symptom relief. Purpose To use magnetic resonance diffusion tensor imaging (MR-DTI) to determine the association between diffusion values of the median nerve (MN) at several anatomic locations and symptom relief in patients with CTS following corticosteroid injection. Material and Methods MR-DTI was performed on 15 wrists of 12 patients with CTS before and two weeks after ultrasound-guided corticosteroid injections. We recorded the patients’ clinical data including sex, age, side of injection, satisfaction, and symptom relief. Satisfaction and symptom relief were rated using a Likert scale and the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scale. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of the MN at the levels of the distal radioulnar joint (DRUJ), pisiform bone, and hamate bone were determined. Results All patients had ≥50% satisfaction on the injection side. In comparison with baseline values, post-injection ADC was significantly lower ( P = 0.001) but FA was not significantly higher ( P = 0.11) at the pisiform bone level on the injected wrists. At the DRUJ and hamate bone levels, no obvious inter-scan change in FA and ADC ( P > 0.05) was observed. The decrease in ADC at the pisiform bone level strongly correlated with the decrease in BCTQ scores (r = 0.628; P = 0.012). Conclusion Symptom relief in patients with CTS receiving corticosteroid injection is related to the change in ADC of the median nerve at the level of the pisiform bone, as determined using MR-DTI.

The long-term follow-up of treatment with corticosteroid injections in patients with carpal tunnel syndrome. When are multiple injections indicated?

2012 ◽  
Vol 38 (6) ◽  
pp. 634-639 ◽  
Author(s):  
M. Berger ◽  
M. Vermeulen ◽  
J. H. T. M. Koelman ◽  
I. N. van Schaik ◽  
Y. B. W. E. M. Roos
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Corticosteroid Injection ◽  
Initial Response ◽  
Response To Treatment ◽  
Good Outcome ◽  
Tunnel Syndrome ◽  
Corticosteroid Injections

The objective of this prospective study was to investigate the long-term effect of one or more local corticosteroid injections in patients with carpal tunnel syndrome and whether a good response can be predicted. Follow-up visits took place at 3 weeks, 6 months, and 1 year after the first corticosteroid injection. Thirty of the 120 patients (25%) had a good outcome with a single injection, 11 additional patients (9%) needed a second injection, and five patients (4%) needed a third injection to reach a good outcome after 1 year. Of patients with an initial good treatment response, 28 (52%) had a good outcome after 1 year compared with 18 (27 %) who had an initially moderate or no response to treatment. One-third of patients with carpal tunnel syndrome had a long-term beneficial effect from corticosteroid injection, especially when they had a good initial response.

Ultrasound-Guided Corticosteroid Injection in Patients with Carpal Tunnel Syndrome: Efficacy of Intra-Epineurial Injection

2017 ◽  
Vol 39 (03) ◽  
pp. 334-342 ◽  
Author(s):  
Yi-Chih Hsu ◽  
Fu-Chi Yang ◽  
Hsian-He Hsu ◽  
Guo-Shu Huang
Keyword(s):  
Patient Satisfaction ◽  
Carpal Tunnel Syndrome ◽  
Clinical Data ◽  
Carpal Tunnel ◽  
Corticosteroid Injection ◽  
Symptom Relief ◽  
Satisfaction Scale ◽  
Cross Sectional ◽  
Tunnel Syndrome ◽  
Us Findings

Abstract Purpose To identify the ultrasound (US) findings of intra-epineurial corticosteroid injection during US-guided hydrodissection in patients with carpal tunnel syndrome (CTS), and to determine their clinical relevance in relation to treatment outcomes. Materials and Methods We performed 101 US-guided hydrodissections and corticosteroid injections in 101 patients with CTS, and evaluated their pre- and post-injection US findings. We categorized these injections into two groups based on the occurrence of intra-epineurial injection. We also recorded clinical data including sex, age, side of injection, BMI, and the duration of pre-injection CTS-related discomfort. The outcomes were measured using the Likert satisfaction scale and Boston Carpal Tunnel Questionnaire (BCTQ) scores. The clinical data, cross-sectional area of the median nerve (CSA-MN) at the inlet of the carpal tunnel measured on US images, and the symptom relief for the patients receiving intra-epineurial and extra-epineurial injection were compared. Results The intra-epineurial injection rate was 38.6 % in the 101 US-guided injections. The clinical data, pre-injection CSA-MN at the inlet of the carpal tunnel, and pre-injection BCTQ scores showed no significant intergroup differences (p > 0.05). The group with intra-epineurial injections had significantly decreased CSA-MN (difference in means, 2.5 mm2; p < 0.0001), greater patient satisfaction (p = 0.002), and lower BCTQ scores (p < 0.05) than the group with extra-epineurial injections. Conclusion We characterized the US findings of intra-epineurial corticosteroid injection during US-guided hydrodissection. Intra-epineurial injection provided a more meaningfully reduction in edema of the MN, greater patient satisfaction, and greater symptom relief than extra-epineurial injection.

scholarly journals OBLIGATORY ALTERATIONS IN THE MORPHOLOGY OF MEDIAN NERVE: A SONOGRAPHIC STUDY IN ASYMPTOMATIC INDIVIDUALS

2018 ◽  
Vol 26 (2) ◽  
Author(s):  
Vandana Lakra ◽  
Garima Sehgal ◽  
Jyoti Chopra ◽  
Anita Rani ◽  
Kaweri Dande
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
Linear Probe ◽  
Tunnel Syndrome ◽  
Asymptomatic Individuals ◽  
Flattening Ratio

Introduction: Median nerve is formed in axilla by contributions from medial and lateral cords of brachial plexus. It descends in the arm, forearm and then through carpal tunnel in close conjunction with flexor tendons of forearm. Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. Median nerve cross sectional area (CSA) and ratio of nerve major axis to minor axis (flattening ratio) serve as potential diagnostic criteria for carpal tunnel syndrome. Median nerve cross sectional area and flattening ratio (FR) can be assessed by ultrasonography (US). Aim of the study was to assess median nerve by US and tabulate mean values for CSA and FR in asymptomatic population. This would serve to limit the cut-off values that differentiate asymptomatic nerves from neuropathic nerves. Material & Methods: Study was conducted in the Department of Anatomy, KGMU, Lucknow. Fifty randomly selected asymptomatic volunteers (undergraduate students: 30 males, 20 females) participated in the study. Sonography was performed to evaluate certain morphological dimensions of median nerve. Height, weight and wrist circumference of participants were also noted. Ultrasonography was performed using high frequency linear probe and observations were made at two pre-determined sites. Observations were recorded, tabulated and analyzed. Results: Median nerve was easily observable at both sites. It was round in shape in forearm (Fo), and flattened as it reached the carpal tunnel (Ct). Among all 50 study subjects, at both sites, flattening was more on right side (FRFoRt-1.71; FRCtRt-3.08) than on left side (FRFoLt-1.66; FRCtLt-2.78). In right forearm, nerve was flatter in females (FRFoRt-1.77) as compared to males (FRFoRt-1.68). In left forearm, median nerve was slightly rounder in females (FRFoLt-1.65) as compared to males (FRFoLt-1.67). At the distal wrist crease on right side, increased flattening was observed in females (FRCtRt-3.30) as compared to males (FRCtRt-2.94), whereas on left side, at same site flattening was more in females (males FRCtLt-2.74; females FRCtLt-2.83). Conclusion: Altered FR has both diagnostic as well as prognostic values in carpal tunnel syndrome. The database generated from the study will help in facilitating comparisons between normal, asymptomatic and pathological, asymptomatic individuals.

scholarly journals The SToICAL trial: study protocol for the soft tissue injection of corticosteroid and local anaesthetic trial—a single site, non-inferiority randomised control trial evaluating pain after soft tissue corticosteroid injections with and without local anaesthetic

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
M. Jones ◽  
J. Evans ◽  
S. Fullilove ◽  
E. Doyle ◽  
C. Gozzard
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Soft Tissue ◽  
Clinical Diagnosis ◽  
Carpal Tunnel ◽  
Local Anaesthetic ◽  
Corticosteroid Injection ◽  
Randomised Control Trial ◽  
Tunnel Syndrome ◽  
Vas Scores ◽  
Corticosteroid Injections

Abstract Background Corticosteroid injections are used in the treatment of hand and wrist conditions. The co-administration of a local anaesthetic and corticosteroid aims to reduce pain after the injection, although no studies have directly compared this with using corticosteroid alone. The aim is to determine whether pain experienced during the 24 h after a corticosteroid injection to the hand and wrist is no worse than (not inferior to) the pain experienced after a corticosteroid and local anaesthetic injection. Methods A single-site, patient- and assessor-blinded, non-inferiority randomised control trial recording pain visual analogue scale (VAS) scores in patients with a clinical diagnosis of trigger finger, de Quervains tenosynovitis or carpal tunnel syndrome, treated with a 1-ml triamcinolone (40 mg/1 ml) injection co-administered with or without 1 ml of 1% lidocaine. The primary aim is to investigate a difference in pain VAS scores at 1 h after the injection using a mean change score. A 95% power calculation was made using a minimally clinical important difference of 20 mm as the clinically admissible margin of non-inferiority and an assumed standard deviation of 25 mm, from previous studies. Including a 20% fall out rate, 100 patients are required. Discussion Patients with a clinical diagnosis of trigger finger, de Quervains and carpal tunnel syndrome, are over the age 18 years old and who are able to give written informed consent will be included. Patients will be excluded if they have had previous surgery or corticosteroid injection for the condition being treated at the site considered for injection. Patients will be electronically randomised and injections delivered during their clinic appointment. Pain is assessed using a 100-mm VAS score taken, before and at the time of injection and at 5 min, 1 h, 2 h, 3 h and 24 h after the injection. The secondary outcomes are to determine a difference in pain VAS score at the time of injection and during the 24 h after. Trial registration This study is registered on the IRAS (259336) on November 11, 2019, and EudraCT database on October 31, 2019 (2019-003742-32). REC/HRA approval was given in January 2020, and Clinical Trial Authorisation from the MHRA was given in December 2019. The study is registered on ClinicalTrials.gov (NCT04253457) on February 5, 2020.

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