scholarly journals OUR EXPERIENCE IN CARPAL TUNNEL SYNDROME THERAPEUTIC EFFECTIVENESS EVALUATION

2019 ◽  
Vol 7 ◽  
pp. 833-838
Author(s):  
Jolanta Umure ◽  
Ināra Logina ◽  
Marija Mihailova
Keyword(s):  
Neuropathic Pain ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Corticosteroid Injection ◽  
Motor Nerve ◽  
Clinical Effectiveness ◽  
University Hospital ◽  
Compression Tests ◽  
Neurophysiological Studies ◽  
Tunnel Syndrome

Objectives: Analyze the literature data on the incidence and manifestation of carpal tunnel syndrome (CTS), as well as the pathogenesis and treatment options. Perform a specially designed, validated test - Pain Detection. Evaluate the objective state of patients with CTS - sensory impairment, compression test. Assess patients’ neurologic and neurophysiologic data before and after the blockade and evaluate its effectiveness. Perform a specially designed, validated test - Patients` Global Impression of Change scale (PGIC) one month after corticosteroid injection (CSI).Methods and Materials: The study includes an analysis of 55 arms of patients of different age with mild and moderate CTS who came for a neurological examination at the Neurology Outpatient Department of the Pauls Stradiņš Clinical University Hospital during the period of 01.08.2018 – 01.01.2019. All patients were analyzed clinically and neurophysiologically before CSI and one month after CSI. A Pain Detect scale, PGIC scale, compression tests and sensory tests were used for the evaluation of clinical symptom. A median nerve sensory and motor nerve conduction study was performed.Results: According to the Pain Detect scale, 60% of patients showed neuropathic pain before CSI, and 78% of patients presented clinical effectiveness after CSI. 98% of patients present clinical effectiveness after CSI in the PGIC scale. 85% of patients had improvement in neurophysiological studies – motor distal latency decreased after CSI. Before CSI, the average motor distal latency was 5.7ms (range 4.5-12.9ms SD±1.5), which was on average 130% from the maximal norm (range 102- 293 SD±36). After the CSI, the average motor distal latency was 5.2ms (range 3.8-10.7ms SD±1.3), which was on average 120% from the maximal norm (range 88-243 SD±30). We didn’t find any significant correlation between the improvement of the patient's clinical condition and the improvement of electrophysiological outcomes.Conclusions: The study concludes that the Pain Detect sensitivity for neuropathic pain evaluation of patients with CTS is 60%. Patients show clinical and neurophysiological improvement after CSI, but there is no correlation between neurophysiological and clinical improvement. The study concludes that the PGIC scale can be used to quickly assess the effectiveness of therapy.

Prognostic factors in carpal tunnel syndrome treated with a corticosteroid injection

2011 ◽  
Vol 44 (5) ◽  
pp. 763-768 ◽  
Author(s):  
Vera Meys ◽  
Sam Thissen ◽  
Stan Rozeman ◽  
Roy Beekman
Keyword(s):  
Prognostic Factors ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Corticosteroid Injection ◽  
Tunnel Syndrome

scholarly journals Intra-Carpal Injection of Ozone versus Methylprednisolone in Carpal Tunnel Syndrome of Systemic Sclerosis Patients: A Randomized Single-Blind Clinical Trial

2021 ◽  
pp. E453-E458
Keyword(s):  
Systemic Sclerosis ◽  
Carpal Tunnel Syndrome ◽  
Functional Status ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Favourable Outcome ◽  
University Hospital ◽  
Electrophysiologic Study ◽  
Tunnel Syndrome

BACKGROUND: Carpal tunnel syndrome (CTS) is the most entrapment syndrome in general and is the most frequent peripheral nervous system involvement in systemic sclerosis (SSc). Local injection of steroid hydrodissection or ozone-oxygen showed favourable outcome in CTS in general. OBJECTIVES: To compare the clinical efficacy of ozone versus methylprednisolone intracarpal injection upon pain, functional status, and nerve conduction in patients with CTS due to SSc. STUDY DESIGN: A randomized single-blinded trial. SETTING: Anesthesia, pain, and rheumatology clinics in a university hospital. METHODS: Fifty CTS patients with > 3 months duration of SSc were equally randomized into either group O (injection of ozone/oxygen 25 mu-g/mL in 20 mL) or group M (methylprednisolone acetate 40mg, and 40 mg lidocaine in 20 mL). Visual analog scale (VAS) was measured pre-injection, then re-evaluated post-injection at 4 time points (1 week, 1 month, 3 months , and 6 months); Cochin Hand Function Scale (CHFS); and a median nerve electrophysiologic study was done before injection, then by the end of 3 months and 6 months. RESULTS: VAS was significantly lower in group M after 1 week (P = 0.01). Group O showed significantly lower VAS after 3 and 6 month (P < 0.001). Additionally, there was a significant decrease in the VAS during the whole study period within each group, in comparison to its baseline value. CHFS was significantly lower in the ozone group after 6 months (P < 0.001). The sixth month’s sensory conduction was significantly higher in group O (P = 0.002). The motor distal latency was significantly lower in the ozone group after 3 and 6 months (P < 0.001). LIMITATIONS: Follow-up period could be furtherly extended. CONCLUSION: Both intracarpal ozone or methylprednisolone afford favorable effects upon CTS in patients with SSc. However, ozone alleviates pain much more, enhances the hand functional status, and improves median nerve conduction in study with over six months duration. KEY WORDS: Carpal Tunnel Syndrome, systemic sclerosis, methylprednisolone, ozone

scholarly journals Effect of preoperative gabapentin on pain intensity and development of chronic pain after carpal tunnel syndrome surgical treatment in women: randomized, double-blind, placebo-controlled study

2016 ◽  
Vol 134 (4) ◽  
pp. 285-291 ◽  
Author(s):  
Eduardo Jun Sadatsune ◽  
Plínio da Cunha Leal ◽  
Rachel Jorge Dino Cossetti ◽  
Rioko Kimiko Sakata
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Surgical Treatment ◽  
Postoperative Pain ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Postoperative Analgesia ◽  
Pain Syndrome ◽  
Double Blind ◽  
Tunnel Syndrome

ABSTRACT CONTEXT AND OBJECTIVES: Effective postoperative analgesia is important for reducing the incidence of chronic pain. This study evaluated the effect of preoperative gabapentin on postoperative analgesia and the incidence of chronic pain among patients undergoing carpal tunnel syndrome surgical treatment. DESIGN AND SETTINGS: Randomized, double-blind controlled trial, Federal University of São Paulo Pain Clinic. METHODS: Forty patients aged 18 years or over were randomized into two groups: Gabapentin Group received 600 mg of gabapentin preoperatively, one hour prior to surgery, and Control Group received placebo. All the patients received intravenous regional anesthesia comprising 1% lidocaine. Midazolam was used for sedation if needed. Paracetamol was administered for postoperative analgesia as needed. Codeine was used additionally if the paracetamol was insufficient. The following were evaluated: postoperative pain intensity (over a six-month period), incidence of postoperative neuropathic pain (over a six-month period), need for intraoperative sedation, and use of postoperative paracetamol and codeine. The presence of neuropathic pain was established using the DN4 (Douleur Neuropathique 4) questionnaire. Complex regional pain syndrome was diagnosed using the Budapest questionnaire. RESULTS: No differences in the need for sedation, control over postoperative pain or incidence of chronic pain syndromes (neuropathic or complex regional pain syndrome) were observed. No differences in postoperative paracetamol and codeine consumption were observed. CONCLUSIONS: Preoperative gabapentin (600 mg) did not improve postoperative pain control, and did not reduce the incidence of chronic pain among patients undergoing carpal tunnel syndrome surgery.

scholarly journals Efficacy of Local Corticosteroid in Idiopathic Carpal Tunnel Syndrome: A Randomized Controlled Trial

2013 ◽  
Vol 28 (1) ◽  
pp. 10-15
Author(s):  
Anis Ahmed ◽  
Md Rafiqul Islam ◽  
Hasan Zahidur Rahman ◽  
Md Moniruzzaman Bhuiyan ◽  
Sukumar Majumder ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Steroid Injection ◽  
Corticosteroid Injection ◽  
Controlled Trial ◽  
Oral Steroid ◽  
Steroid Group ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome ◽  
Local Steroid Injection

Background: Carpal tunnel syndrome (CTS) is a common health problem in Bangladesh especially among women. It causes significant morbidity and reduces work output in affected patients. There are few treatment options available like oral steroid, steroid injection, UST, surgical treatment etc. Considering the cost, time and consequence of surgery, short term nonsurgical management is desirable e.g. local steroid injection in the affected limb. Therefore a comparative analysis is necessary to understand the efficacy of local steroid injection.Objective: To evaluate the efficacy of local corticosteroid injection in the treatment of idiopathic carpal tunnel syndrome. Methods: 60 idiopathic CTS patients divided into two groups by randomization. One group received Inj. Triamcinolone 30 mg close to carpal tunnel and other group received oral steroids. Efficacies of treatmemt were compared in between groups.Result: The mean age of two groups were 37.5 ± 10.5 and 37.0 ± 10.24 years respectively (p = 0.272) and Majority of the patients in both treatment groups (76.7% in local steroid and 80% in oral steroid groups, p = 0.754) were female. Relief from tingling sensation and nocturnal awakening was higher in the steroid injection receivers (100% and 86.7% respectively) than that in the oral steroid receivers (6.9% and 3.4% respectively) during evaluation of outcome at the end of 3 month. End point treatment shows that none but SNAP at wrist in the local steroid group improved significantly better than that in the oral steroid group (16.2 ± 10.5 vs. 12.4 ± 6.3, p =0.039). No major side effects occurred in local steroid group except depigmentation in injected area 3 (10%) cases.Conclusion: It may be concluded that local steroid injection is an effective treatment of idiopathic carpal tunnel syndrome. But long-term efficacy of steroid injection remains uncertain.Bangladesh Journal of Neuroscience 2012; Vol. 28 (1): 10-15

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