Ultrasound-Guided Nerve Hydrodissection With 5% Dextrose 4 Weeks After Steroid Injection in Treatment of Carpal Tunnel Syndrome: A Retrospective Study.

Xiao-Mei Wei,Li Jiang,Jiang-Shan Zhang,Zhen-Hai Wei,Zu-Lin Dou,Juan-Juan He,Wei-Xi Zhang

doi:10.3389/fneur.2021.782319

Abstract

ObjectiveTo investigate the efficacy and safety of ultrasound-guided nerve hydrodissection (HD) with 5% dextrose (D5W) as add-on therapy after corticosteroid injection in carpal tunnel syndrome (CTS), and provide a novel strategy.MethodsIn this retrospective study, patients with CTS who received ultrasound-guided nerve HD with D5W as add-on therapy after corticosteroid injection (combination group) were enrolled. Patients who received corticosteroid injection without add-on therapy (steroid group) were recruited as the control group. Ultrasound-guided nerve HD with D5W was performed 4 weeks after corticosteroid injection. Treatment effectiveness were assessed by visual analog scale (VAS) and Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). The assessment was performed at baseline and 4, 8, and 12 weeks after corticosteroid injection. In addition, adverse events were recorded in this study.ResultsA total of 49 patients and 62 wrists meeting the criteria were included, with 24 patients and 31 wrists in the steroid group and 25 patients and 31 wrists in the combination group. Compared with baseline data, both groups showed greater improvement in VAS, BCTQs (BCTQ severity), and BCTQf (BCTQ function) at 4, 8, and 12 weeks follow-up. VAS, BCTQs, and BCTQf scores at baseline and week 4 were comparable between steroid group and combination group. Compared with steroid group, combination group exhibited a significant reduction in VAS, BCTQs, and BCTQf at 8- and 12-week follow-up (P ≤ 0.01). No adverse event occurred in any group.ConclusionsOur results showed that ultrasound-guided nerve HD with D5W as add-on therapy after corticosteroid injection was efficacious and safe in CTS, and combination therapy is more beneficial than corticosteroid monotherapy in the improvement of symptoms and function at 8- and 12-week follow-up.

Highlights

Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy, with an annual incidence rate of 99 in 100,000 people [1]
visual analog scale (VAS), BCTQs, and BCTQf scores at weeks 4 were comparable between steroid group and combination group (P > 0.05) (Table 2)
In a review conducted by Marshall et al the authors found that local corticosteroid injection for CTS provides greater clinical improvement in symptoms 1 month after injection compared to placebo

Summary

Introduction

Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy, with an annual incidence rate of 99 in 100,000 people [1]. It is well-known that 1 in 10 people develop CTS at times, most of whom are older women [2]. CTS can be treated with various methods, such as perineural injection with corticosteroid, especially for the patients who failed conventional non-invasive approaches [3]. We observed that patients still had a certain degree of discomfort, such as numbness and pain, at 4 weeks after perineural injection with corticosteroid. Wu found that perineural injection of D5W is safe and effective for CTS both in the short term and in the long term [5]

Methods

Results

Conclusion