Abstract
Local insulin injection for the median nerve was administered in patients with mild to moderate idiopathic carpal tunnel syndrome (CTS) to evaluate its effectiveness on the median nerve regeneration as it has been suggested that insulin has an effect on nerve regeneration, similar to that of nerve growth factor. This study included 82 patients (130 hands) with clinical and electrophysiologic evidence of mild to moderate idiopathic CTS (grade 3 or less according to Bland’s classification). The 130 hands were randomly assigned to two groups: group I received insulin injection of 10 IU Neutral Protamine Hagedorn known as humulin N (NPH) insulin locally into the affected carpal tunnel at the first visit and a similar dose of insulin after 2 weeks; and group II received a single injection of 40mg triamcinolone acetonide injection into the carpal tunnel. Clinical and electrophysiologic evaluations were carried out at the start of the study and at 1 month after treatment. Patients were evaluated on the basis of the mean score on the Symptom Severity Scale and Functional Status Scale of the Boston Carpal Tunnel Questionnaire. All patients showed a symptomatic and functional improvement. Distal motor latency and distal sensory latency were decreased for both groups (4.84±0.74 vs. 4.61±0.72 and 2.88±0.27 vs. 2.55±0.19, respectively), with a significant decrease in the mean of Functional Status Scale score and Symptom Severity Scale score for patients treated with the insulin injection (2.5±0.6 vs. 2.07±0.55 and 3.13±0.47 vs. 2.23±0.5, respectively). Local insulin injection effectively reduced the symptoms of CTS and improved electrophysiological findings in the present study. Our findings suggest that local insulin injection may be of great benefit in improving nerve functions in patients with mild to moderate idiopathic CTS. Further controlled studies are needed to confirm our preliminary findings and to compare local insulin injection with conventional approaches for the treatment of CTS.
Highlights
Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the upper extremity
Distal motor latency and distal sensory latency were decreased for both groups (4.84±0.74 vs. 4.61±0.72 and 2.88±0.27 vs. 2.55±0.19, respectively), with a significant decrease in the mean of Functional Status Scale score and Symptom Severity Scale score for patients treated with the insulin injection (2.5±0.6 vs. 2.07±0.55 and 3.13±0.47 vs. 2.23±0.5, respectively)
Our findings suggest that local insulin injection may be of great benefit in improving nerve functions in patients with mild to moderate idiopathic carpal tunnel syndrome (CTS)
Summary
Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the upper extremity. The prevalence of CTS in the general population has been estimated to be 1–5% [1]. The pathophysiological mechanism of idiopathic CTS is the increased pressure within the carpal tunnel, which results from an increase in the volume of canal’s contents, of the flexor tenosynovium [3]. Chronic nerve compression produces focal demyelination and in more severe cases there is an axonal degeneration of the nerve fibers [4]. The symptoms include pain, paresthesia, and numbness in the hand area supplied by the median nerve. The pain may radiate proximally and may be more severe at night. Patients may develop motor symptoms such as difficulty in gripping, leading to objects falling out of the hand
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