Effect of Perineural Injection with Different Dextrose Volumes on Median Nerve Size, Elasticity and Mobility in Hands with Carpal Tunnel Syndrome.

Meng-Ting Lin,I-Chun Liu,Chueh-Hung Wu,Wei-Ting Syu,Po-Ling Kuo

doi:10.3390/diagnostics11050849

Meng-Ting Lin, I-Chun Liu + Show 3 more

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https://doi.org/10.3390/diagnostics11050849

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Abstract

This study aimed to investigate the effect of different injectate volumes on ultrasonographic parameters and the correlation to clinical outcomes under perineural dextrose injection (PDI). In this post hoc analysis of the randomized, double-blinded, three-arm trial, ultrasound-guided PDI with either 1 mL, 2 mL, and 4 mL 5% dextrose water was administered, respectively, in 14, 14, and 17 patients. Ultrasound outcomes included mobility, shear-wave elastography (SWE), and cross-sectional area (CSA) of the median nerve; clinical outcomes were Visual Analog Scale (VAS) and Boston Carpal Tunnel Questionnaire (BCTQ) score. Outcomes were measured before injection, and after injection at the 1st, 4th, 12th, and 24th week. For ultrasound outcomes, CSA decreased significantly from baseline data at all follow-up time-points in the 2 mL group (p = 0.005) and the 4 mL group (p = 0.015). The mean change of mobility from baseline showed a greater improvement on the 4 mL group than the other groups at the 1st week post-injection. For clinical outcomes, negative correlation between the VAS and mobility at the 1st (p = 0.046) and 4th week (p = 0.031) post-injection in the 4 mL group were observed. In conclusion, PDI with higher volume yielded better nerve mobility and decreased CSA of median nerve, but no changes of nerve elasticity.

Highlights

Carpal tunnel syndrome (CTS) occur with the symptoms of intermittent nocturnal paresthesia and dysesthesia, followed by loss of sensation, weakness, and thenar muscle atrophy in later stages [1]
Among the 33 participants with 51 wrists that were assessed for eligibility into the trial, four participants were excluded due to rejection to injection
A total of 45 wrists were randomized into three groups (Figure 1)

Summary

Introduction

Carpal tunnel syndrome (CTS) occur with the symptoms of intermittent nocturnal paresthesia and dysesthesia, followed by loss of sensation, weakness, and thenar muscle atrophy in later stages [1]. Etiology of CTS is multifactorial, compression of the median nerve in space-limited osteofibrous canal at wrist level was proposed [1,2]. The gold standard of diagnosis is electrophysiological study, but the ultrasonography was applied in recent decades for better approach to morphology change of median nerve. The cross-sectional area of median nerve became another diagnostic option for CTS [3]. Previous review demonstrated reducing excursion of median nerve in CTS patients [6]. A systemic review revealed the median nerve became stiffer after compression under shear wave elastography quantification [7,8]. Shear wave elastography had high sensitivity to detect changes in median nerve elasticity [9]

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