Abstract
The study aimed to compare the effects of intralesional steroid injection and ultrasound therapy for the treatment of carpal tunnel syndrome. A total 130 patients divided into 2 groups: a) One group (n=65) received intralesional corticosteroid injection along with wrist splint, exercise, naproxen sodium 500 mg tablet and omeprazole 20 mg capsule twice daily for 2 weeks; b) Another group received (n=65) ultrasound therapy (10 min/day, 3 days/week for 4 weeks) along with Wrist splint for 4 weeks, exercises for 4 weeks, naproxen sodium 500 mg tablet and omeprazole 20 mg capsule twice daily for 2 weeks. The patients were followed-up 2 weekly for 4 weeks. The visual analogue score, symptom severity scores and functional status scores were significantly improved within each group at week 2 (p<0.05) and week 4 (p<0.05) except for the symptom severity score at (p>0.05). The improvement in symptom severity scores and functional status scores in the intralesional steroid group was more than in the ultrasound therapy group after 4 weeks.
Highlights
Carpal tunnel syndrome is the most common form of entrapment neuropathy caused by the compression of the median nerve as it passes through the carpal tunnel
The subjects were selected according to the inclusion criteria: a) age ≥18 years; b) patients with complaints of paresthesia and/or pain for at least one month in all or part of the hand territory innervated by the median nerve mainly at night or on waking and/or triggered by certain postures or repetitive forced movements of the fingers or wrist; c) electrophysiological evidence of median nerve entrapment at the wrist; d) no evidence of joint infection, recent trauma, fracture, malignancy, tuberculosis; e) no history of heat sensitivity or skin lesion and f) stable level of activity and would continue the treatment as directed
In total 158 patients were selected according to the criteria and divided into two groups randomly by the way of lottery manually: a) one group (n=80) received intralesional corticosteroid injection (Trialone 20 mg/mL from Drug International Ltd, Bangladesh) along with wrist splint, exercise for 4 weeks, naproxen sodium 500 tablet and omeprazole 20 mg capsule twice daily for 2 weeks; b) Another group received (n=78) ultrasound therapy (10 min/day, 3 days/week for 4 weeks) along with wrist splint for 4 weeks, exercises for 4 weeks, naproxen sodium 500 mg tablet and omeprazole 20 mg capsule twice daily for 2 weeks
Summary
The management is based on relieving the pressure on the median nerve with various conservative and surgical treatment methods. Clinicians strive to build up conservative or less invasive methods. This trend is likely due to three main reasons: a) the recurrence rate of surgical treatment,[1] b) less complication with conservative treatment and c) some patients with carpal tunnel syndrome have spontaneous recovery.[2]. Mild to moderate symptoms are commonly managed with conservative measures.[3] Nonsurgical treatment for carpal tunnel syndrome include wrist splinting, steroid injecttion into the carpal canal, exercises, yoga, therapeutic ultrasound, activity or ergonomic modification and oral medication of vitamins.[4]
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