Response to local corticosteroid injections in carpal tunnel syndrome with normal conduction studies

IntroductionNerve conduction studies (NCS) have been considered as the gold standard in carpal tunnel syndrome (CTS) diagnosis, despite correlation between clinical symptomatology and NCS severity has shown to be poor. In fact, clinical symptoms precede NCS changes in months or years. Few papers have been published about the clinical response to treatment of clinically typical CTS, but with normal NCS (NNCS).ObjectiveTo compare the clinical response to local corticosteroid injections (LCI) in clinically typical CTS, with NNCS and abnormal NCS (ANCS).MethodWe included patients older than 18, with typical CTS symptoms (ongoing daily nocturnal pain/paresthesias in hand, at least during 3 months). Follow-up was done at 3, 6 and 12 months. Primary outcome was the visual analog scale for pain (p-VAS), comparing NNCS CTS wrists with ANCS CTS wrists. Statistic signification was established by the Student's t test, Mann–Whitney's “U”, χ² test and Yates’ correction.ResultsWe included 44 wrists in the NNCS group, and 83 in the ANCS group. There was no statistical significance between data in both groups, except in the 12-month follow-up, where the NNCS group achieved better results than the ANCS group in the 20% response (p = 0.006). There was a trend toward a better 50% response in the 12-month follow-up.ConclusionsOur data suggest that LCI are similarly effective in both CTS with NNCS and ANCS. Nonetheless, there is a mild better effect in NNCS than in ANCS at 12-month follow-up.     

A novel approach of local corticosteroid injection for the treatment of carpal tunnel syndrome

The objective of the study was to compare the favorable response rate, time duration, and pain level of local corticosteroid injection using a novel approach for the treatment of carpal tunnel syndrome vs a classic approach. Patients with symptomatic carpal tunnel syndrome of less than 1-year duration were randomized for local corticosteroid injection using either the classic approach or a novel approach. In our approach (novel), we used a 29 gauge × 1/2-in. needle and a 1-ml insulin syringe containing 12 mg of methylprednisolone mixed with 0.15 ml of lidocaine 2%, and the site of the injection was 2–3 cm distal to the middle of wrist crease. In the classic approach, we used a 25 gauge × 3-cm needle and a 2-ml syringe injecting 35 mg of methylprednisolone mixed with 0.5 ml of lidocaine 2%, 3–4 cm proximal to the wrist crease and just ulnar to the tendon of the flexor carpi radialis muscle. Response rate was evaluated 1, 3, 6, and 12 weeks after the injection, and also the duration of time of the procedure and the level of pain using the visual analogue scale were compared between the two groups. Forty-two patients signed the consent form, and all of them completed the study [21 patients in the classic approach group (group 1) and 21 patients in the novel approach group (group 2)]. The favorable response rates were 100, 81, 71, and 57% in group 1 and 100, 71, 67, and 57% in group 2 after 1, 3, 6, and 12 weeks, respectively. There was no significant difference in the favorable response rate between the two groups (p=0.468, 95% CI=−12–31%, after 3 weeks). The average duration of time of the procedure in group 1 was 26.71±32.83 s compared to 8.48±1.123 s (p=0.021) in group 2. The average grade of pain expressed by the patients in group 1 was 4.38±1.523 compared to 3.62±1.071 in group 2 (p=0.065). In conclusion, local corticosteroid injection using the novel approach for the treatment of carpal tunnel syndrome is helpful, and the favorable response rates are comparable to those using the classic approach after 1, 3, 6, and 12 weeks. The novel approach is much less time consuming and is not more painful.     

Comparison of splinting, splinting plus local steroid injection and open carpal tunnel release outcomes in idiopathic carpal tunnel syndrome

The objective of this study was to compare the short- and long-term efficacies of splinting (S), splinting plus local steroid injection (SLSI), and open carpal tunnel release (OCTR) in mild or moderate idiopathic carpal tunnel syndrome (CTS). Patients with mild or moderate idiopathic CTS who experienced symptoms for over 6 months were included in the study. The patients were evaluated for the baseline and the third and sixth month scores after treatment. Follow-up criteria were ENMG parameters, Boston Questionnaire, and patient satisfaction. Fifty-seven hands completed the study. Twenty-three hands had been splinted for 3 months. Twenty-three hands were given a single steroid injection and splinted for 3 months, and 11 hands were operated. In the first 3 months, all treatment methods provided significant improvements in both clinical and EMG parameters in which OCTR had better outcomes on median sensorial nerve velocity at palm wrist segment. In the second 3 months, while the clinical and EMG parameters began to deteriorate in S and SLSI group, OCTR group continued to improve, and BQ functional capacity score of OCTR group was statistically better than that in conservative methods (P = 0.03). S and SLSI treatments improved clinical and EMG parameters comparable to OCTR in short term. However, these beneficial effects were transient in the sixth month follow-up and OCTR was superior to conservative treatments.     

Comparison of open carpal tunnel release and local steroid treatment outcomes in idiopathic carpal tunnel syndrome

To compare the efficacy of local steroid injection and open carpal tunnel release, a symptom and functional status questionnaire (Boston Questionnaire) and sensory and motor nerve conduction studies were performed in 90 patients with electrophysiologically proven idiopathic carpal tunnel syndrome, of whom 44 were treated surgically and 46 by two-dose steroid injection. Electrophysiologic studies and the Boston Questionnaire were applied before and at the 3rd and 6th months after treatment. Both groups showed significant improvement at first follow-up. The surgically treated group showed a significant and further improvement of symptoms and conduction values between the 3rd- and 6th-month evaluations, whereas no significant change was observed in the patient group treated by steroid injection. By the end of follow-up, 5% of the hands in the open carpal tunnel release (OCTR) group and 13% of the hands in the local steroid injection (LSIG) group showed electrophysiological worsening, and 5% of the hands in the OCTR group and 22% of the hands in the LSIG group showed symptomatic worsening. Our results show that steroid injection provides an improvement comparable with that from surgical release of the median nerve at a 3-month interval. However, this improvement is not long-lasting.     

Corticosteroid injection for the treatment of carpal tunnel syndrome

OBJECTIVE: To compare low and high dose, and short and long acting corticosteroids in the treatment of carpal tunnel syndrome. METHODS: A randomised, controlled, single blind trial with electromyographic and subjective outcome measures. RESULTS: 25 mg hydrocortisone is as effective as higher doses or long acting triamcinolone at a six week and six month follow up. CONCLUSION: As low dose steroid is as effective, and potentially less toxic, this should be the recommended dose for injection of carpal tunnel syndrome.     

Nerve conduction studies as a routine diagnostic aid in carpal tunnel syndrome

SIR, Carpal tunnel syndrome (CTS) is the most common nerve entrapmentdisorder and is a frequent diagnosis made in rheumatology. Itis characterized by pain and paraesthesia and may ultimatelylead to muscle wasting of the hand. The diagnosis of this disorderis often clinical with nerve conduction studies (NCS) as a diagnosticaid. We wished to assess     

High-resolution ultrasonography in carpal tunnel syndrome: role of ancillary criteria in diagnosis and response to steroid injection

Clinical Rheumatology - (1) Development and validation of a composite ultrasound score (cUSS) for the diagnosis of carpal tunnel syndrome (CTS). (2) To predict treatment response after local...     

Diagnostic utility of ultrasonography versus nerve conduction studies in mild carpal tunnel syndrome

OBJECTIVE: To prospectively compare high-resolution ultrasonography (US) and nerve conduction velocity (NCV) in clinically diagnosed mild carpal tunnel syndrome (CTS). METHODS: Eighty-five patients (70 women and 15 men, mean age 46.8 years) reported symptoms compatible with classic/probable CTS. The protocol included NCV of the median and ulnar nerves (distal motor latency [DML], sensory conduction velocity [SCV] from the third [M3 SCV] and fourth fingers [M4 SCV] to the wrist for the median nerve); electrophysiologic severity scale; self-administered Levine/Boston questionnaire (BQ); and cross-sectional area (CSA) measurement of the nerve at the tunnel inlet (CSA-I), at the middle (CSA-M), and at the outlet (CSA-O). Relationship between age, body mass index, duration of symptoms, CSAs, NCV, electrophysiologic severity scale, and BQ scores was calculated. Concordance between CSAs and NCV, sensitivity of NCV and US was also evaluated. RESULTS: The mean values of CSA-I, CSA-M, and CSA-O were 10.3, 9.8, and 8.7 mm2, respectively. Relationships were found between CSA-I and M3 SCV (r = -0.45), M4 SCV (r = -0.56), and median nerve DML (r = 0.29). Anomalous CSA-I, CSA-M, and CSA-O were found in 48, 25, and 26 patients, respectively; 55 (64.7%) had > or =1 abnormal CSA. NCV abnormalities were found in 67%. The sensitivity increased to 76.5% if US and NCV were considered together. The highest concordance to detect absence/presence of abnormalities was between CSA-I and NCV (77.6%; kappa = 0.52). CONCLUSION: In mild cases of CTS, US did not detect more anomalies than NCV and vice versa, and no anomalies were detected with either diagnostic instrument in 23.5% of mild cases.     

Ultrasound-guided injection of carpal tunnel syndrome: A comparative study to blind injection

Background

Carpal tunnel syndrome (CTS) is the most common upper limb neuropathy with increasing incidence especially among females, having a high economic and social impact on patients. CTS can be treated either with conservative measures or surgically. Steroid injection, as a conservative treatment, could be carried out using anatomical landmarks or via ultra-sonographic guidance.

Platelet-rich plasma versus corticosteroid injections for carpal tunnel syndrome: Clinical and electrophysiological study

Aim of the workTo evaluate the effectiveness of platelet rich plasma (PRP) injections in carpal tunnel syndrome (CTS) in comparison to corticosteroids clinically and electrophysiologically.Patients and methodsThe study included 36 patients with idiopathic mild to moderate CTS divided into two groups: group I received PRP and group II received corticosteroid injections into the carpal tunnel. Nerve conduction studies were carried out, visual analogue scale (VAS) and the Boston Carpal Tunnel Questionnaire (BCTQ) were administered to patients of both groups immediately before treatment, one and three months after treatment.ResultsThe mean age (36.6 ± 8.8 years vs 38.5 ± 8 years), disease durations (19 ± 11 months vs 14 ± 9 months) and genders were comparable. PRP injection was significantly better than corticosteroids injection as regard VAS, symptom severity scale (SSS), functional status scale (FSS) of BCTQ as well as the distal sensory latency after one and three months of injection. There was no significant difference between both groups in other assessed parameters including distal motor latency, amplitude of compound muscle action potential, motor and sensory conduction velocities of the median nerve. There was a significant correlation between VAS and distal sensory and motor latency of the median nerve in both groups before, 1 and 3 months after injection.ConclusionsSingle local injection of the PRP proved to be an effective treatment choice for CTS. PRP therapy seemed to be superior to steroid, showing more improvement clinically as regard the pain and function and electrophysiologically as regard the distal sensory latency throughout the follow-up period.     

糖尿病周围神经病变神经传导速度、F波及皮肤交感反应的变化及临床意义

目的 探讨糖尿病周围神经病变（DPN）患者神经传导速度（NCV）、F波及交感神经皮肤反应（SSR）的变化特点及临床应用价值.方法 97例DPN患者进行神经电生理检查,包括运动神经传导速度（MCV）、感觉神经传导速度（SCV）、F波及SSR检测.结果 异常率分别为SSR 75.2％,NCV 48.8％,F波34.5％,下肢神经病变重于上肢（P＜0.05）.结论 NCV、F波及SSR联合应用可全面地评估糖尿病周围神经的损害,三者相辅相成,缺一不可.     

Ultrasound assessment of carpal tunnel in rheumatoid arthritis and idiopathic carpal tunnel syndrome

Clinical Rheumatology - To comparatively assess the sonographic spectrum of carpal tunnel syndrome (CTS) in patients with rheumatoid arthritis (RA) and in patients with idiopathic CTS. Fifty-seven...     

The efficacy of local steroid injections in idiopathic carpal tunnel syndrome: a double-blind study

In order to investigate the superiority of local steroid injection over the intramuscular route, 37 patients with idiopathic carpal tunnel syndrome were treated with local or systemic steroid injections in a double-blind study. The first group received steroid injections into the carpal tunnel of the more severely affected hand and placebo into the deltoid muscle of the same side. The second group received steroid injections intramuscularly, and placebo into the carpal tunnel. The only significant improvement observed at the end of one month was in the steroid-injected hands of the first group. At 10-12 months follow-up only four (22%) of the 18 patients from this Group were symptom free.     

The carpal tunnel syndrome. Diagnosis and treatment

The carpal tunnel syndrome is the most frequent cause of acroparesthesias of the upper limb. It affects women in 80% of the cases. Classically its diagnosis rests on clinical data; sensory manifestations, more marked at night, are seen earlier than motor manifestations which appear later. In the relatively frequent cases where the topography of the pain is atypical, electromyography represents a determining diagnostic factor. The treatment, initially, is based on steroids infiltrations within the tunnel, representing a true diagnostic test. In case of failure of the medical treatment, especially when there are signs of motor denervation, the surgical decompression of the median nerve is mandatory, with division of the anterior carpal ligament and possibly completed by a careful neurolysis.     

Ultrasound-guided insulin injection for carpal tunnel syndrome in type 2 diabetes mellitus patients

Clinical Rheumatology - To compare effectiveness of ultrasound-guided local insulin injection, local steroid injection, and local steroid followed by insulin injections in treating mild to moderate...