Ultrasound-Guided Pulsed Radiofrequency for Carpal Tunnel Syndrome: A Single-Blinded Randomized Controlled Study.

Jiunn-Tay Lee,Cheng-Wen Ho,Feng-Mei Shih,Liang-Cheng Chen,Yung-Tsan Wu,Tsung-Ying Li,Chia-Hung Sun,Sam Eldabe

doi:10.1371/journal.pone.0129918

Abstract

ObjectiveWe assessed the therapeutic efficiency of ultrasound-guided pulsed radiofrequency (PRF) treatment of the median nerve in patients with carpal tunnel syndrome (CTS).MethodsWe conducted a prospective, randomized, controlled, single-blinded study. Forty-four patients with CTS were randomized into intervention or control groups. Patients in the intervention group were treated with PRF and night splint, and the control group was prescribed night splint alone. Primary outcome was the onset time of significant pain relief assessed using the visual analog scale (VAS), and secondary outcomes included evaluation of the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) results, cross-sectional area (CSA) of the median nerve, sensory nerve conduction velocity (SNCV) of the median nerve, and finger pinch strength. All outcome measurements were performed at 1, 4, 8, and 12 weeks after treatment.ResultsThirty-six patients completed the study. The onset time of pain relief in the intervention group was significantly shorter (median onset time of 2 days vs. 14 days; hazard ratio = 7.37; 95% CI, 3.04–17.87) compared to the control group (p < 0.001). Significant improvement in VAS and BCTQ scores (p < 0.05) was detected in the intervention group at all follow-up periods compared to the controls (except for the severity subscale of BCTQ at week 1). Ultrasound-guided PRF treatment resulted in a lower VAS score and stronger finger pinch compared to the control group over the entire study.ConclusionsOur study shows that ultrasound-guided PRF serves as a better approach for pain relief in patients with CTS.Trial RegistrationClinicalTrials.gov NCT02217293

Highlights

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment neuropathy, which is caused by the compression of median nerve in the carpal tunnel
The onset time of pain relief in the intervention group was significantly shorter compared to the control group (p < 0.001)
Significant improvement in visual analog scale (VAS) and Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scores (p < 0.05) was detected in the intervention group at all follow-up periods compared to the controls

Summary

Introduction

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment neuropathy, which is caused by the compression of median nerve in the carpal tunnel. The average prevalence of CTS is 3–4% with a female predominance (7% female and 1% male), and it is more common in certain occupational populations such as computer users, meatpackers, and cashiers [1]. Repetitive stress of the wrist, obesity, and pregnancy are the main risk factors for CTS, and secondary causes, such as lesions within the carpal tunnel, metabolic causes, and infection have been reported [2]. Katz et al [4] revealed that around 60–70% of patients with CTS treated conservatively remained symptomatic after 18 months. A treatment failure rate of 69% (57 of 83 patients) was reported after a 12-months follow-up period [5]

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Conclusion