The Effectiveness of Ultrasound-Guided Steroid Injection Combined with Miniscalpel-Needle Release in the Treatment of Carpal Tunnel Syndrome vs. Steroid Injection Alone: A Randomized Controlled Study.

Subo Zhang,Cuicui Liu,Shaoling Wu,Wenjun Xin,Caina Lin,Fei Wang,Chao Ma,Songjian Ke

doi:10.1155/2019/9498656

Abstract

Objectives Carpal tunnel syndrome (CTS) is one of the most common nerve entrapment syndromes, which has a serious impact on patients' work and life. The most effective conservative treatment is steroid injection but its long-term efficacy is still not satisfactory. The aim of this study was to evaluate the effectiveness of steroid injection combined with miniscalpel-needle (MSN) release for treatment of CTS under ultrasound guidance versus steroid injection alone. We hypothesized that combined therapy could be more beneficial. Methods Fifty-one patients with CTS were randomly allocated into two groups, namely, steroid injection combined with MSN release group and steroid injection group. The therapeutic effectiveness was evaluated using Boston Carpal Tunnel Questionnaire (BCTQ), cross-sectional area (CSA) of the median nerve, and four electrophysiological parameters, including distal motor latency (DML), compound muscle action potential (CMAP), sensory nerve action potential (SNAP), and sensory nerve conduction velocity (SNCV) at baseline, 4 and 12 weeks after treatment. Results Compared with baseline, all the parameters in both groups showed statistically significant improvement at week 4 and week 12 follow-up, respectively (P<0.05). When compared with steroid injection group, the outcomes including BCTQ, DML, CMAP, SNCV, and CSA of the median nerve were significantly better in steroid injection combined with MSN release group at week 12 after treatment (P<0.05). Conclusions The effectiveness of steroid injection combined with MSN release for CTS is superior to that of steroid injection alone, which may have important implications for future clinical practice. This Chinese clinical trial is registered with ChiCTR1800014530.

Highlights

Carpal tunnel syndrome (CTS) is the most common and widely studied nerve entrapment syndrome, accounting for 90% of all such disorders [1]
Patients were excluded from this study for the following: (1) symptomatic CTS because of diabetes, thyroid disease, or rheumatic disease, (2) cervical radiculopathy or other polyneuropathy, (3) age
After screening by inclusion and exclusion criteria, a total of 51 patients (51 wrists) with carpal tunnel syndrome were included and randomly assigned into 2 groups, with patients (25 wrists) in steroid injection combined with MSN release (Group A) and patients (26 wrists) in steroid injection (Group B)

Summary

Introduction

Carpal tunnel syndrome (CTS) is the most common and widely studied nerve entrapment syndrome, accounting for 90% of all such disorders [1]. Patients with CTS mainly experience pain and paresthesias in the distribution of the median nerve, which includes the palmar aspect of the thumb, index and middle fingers, and radial half of the ring finger [3]. This syndrome often brings serious problems to patients’ life and work. Even if steroid injection temporarily improves symptoms in some patients with CTS, it does not completely obviate the longterm need for surgery [8,9,10,11] This may be due to the fact that injections fail to directly release and decompress the carpal tunnel

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Conclusion