Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy,
which results from median nerve compression. A lot of nonsurgical modalities are available for the
management of mild to moderate situations. Local Hyalase hydrodissection (HD) of the entrapped
median nerve could offer a desirable sustained symptom alleviation.
Objectives: To evaluate the clinical efficacy of Hyalase/saline solution carpal tunnel HD on pain,
functional status, and nerve conduction in patients with CTS.
Study Design: A randomized, double-blinded trial.
Setting: Anesthesia, pain, and rheumatology clinics in a university hospital.
Methods: Patients: 60 patients with CTS (> 6 months’ duration). Intervention: patients were
allocated equally into either group 1 (HD with Hyalase + 10 mL saline solution injection), or group 2
(HD with 10 mL saline solution only). Measurements: assessment of pain using Visual Analog Scale
(VAS), functional disability (FD) score, and nerve conduction studies before injection, and over 6
months after injection. Nerve conduction parameters before injection and postinjection by the end
of 3 and 6 months were evaluated as well.
Results: Statistically significant lower postinjection values of VAS (1 ± 1.8, 2 ± 1.1, 2 ± 1.2, 2 ±
1.1) in group 1 versus (2 ± 1.2, 3 ± 1.7, 4 ± 1.5, 5 ± 2.6) in group 2 by the end of the first week,
and the first, third, and sixth months, and significantly lower FD scores (15.3 ± 1.2, 13 ± 1.3, 10.2
± 1.3, 10.2 ± 1.3) in group 1 versus (17.5 ± 1.8, 16.6 ± 2.8, 19.4 ± 3.2, 21.2 ± 2.5) in group
2 during the same time intervals. Nerve conduction study parameters have shown significantly
higher velocity and lower latency in the Hyalase group than in the saline solution group by the 3
and 6 month follow-up.
Limitation: We suggest a longer period could be reasonable.
Conclusions: Carpal tunnel HD with Hyalase with saline solution is considered as an efficient
technique offering a rapid onset of pain relief and functional improvements, and better median
nerve conduction in patients with CTS over 6 months follow-up duration.
Key words: Carpal tunnel syndrome, Hyalase, median nerve hydrodissection