Effect of Perineural Injection with Different Dextrose Volumes on Median Nerve Size, Elasticity and Mobility in Hands with Carpal Tunnel Syndrome

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Abstract

This study aimed to investigate the effect of different injectate volumes on ultrasonographic parameters and the correlation to clinical outcomes under perineural dextrose injection (PDI). In this post hoc analysis of the randomized, double-blinded, three-arm trial, ultrasound-guided PDI with either 1 mL, 2 mL, and 4 mL 5% dextrose water was administered, respectively, in 14, 14, and 17 patients. Ultrasound outcomes included mobility, shear-wave elastography (SWE), and cross-sectional area (CSA) of the median nerve; clinical outcomes were Visual Analog Scale (VAS) and Boston Carpal Tunnel Questionnaire (BCTQ) score. Outcomes were measured before injection, and after injection at the 1st, 4th, 12th, and 24th week. For ultrasound outcomes, CSA decreased significantly from baseline data at all follow-up time-points in the 2 mL group ( p = 0.005) and the 4 mL group ( p = 0.015). The mean change of mobility from baseline showed a greater improvement on the 4 mL group than the other groups at the 1st week post-injection. For clinical outcomes, negative correlation between the VAS and mobility at the 1st ( p = 0.046) and 4th week ( p = 0.031) post-injection in the 4 mL group were observed. In conclusion, PDI with higher volume yielded better nerve mobility and decreased CSA of median nerve, but no changes of nerve elasticity.

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Most cited references 29

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Carpal tunnel syndrome: clinical features, diagnosis, and management.

Lisa Hobson-Webb, Luca Padua, Daniele Coraci … (2016)

Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome worldwide. The clinical symptoms and physical examination findings in patients with this syndrome are recognised widely and various treatments exist, including non-surgical and surgical options. Despite these advantages, there is a paucity of evidence about the best approaches for assessment of carpal tunnel syndrome and to guide treatment decisions. More objective methods for assessment, including electrodiagnostic testing and nerve imaging, provide additional information about the extent of axonal involvement and structural change, but their exact benefit to patients is unknown. Although the best means of integrating clinical, functional, and anatomical information for selecting treatment choices has not yet been identified, patients can be diagnosed quickly and respond well to treatment. The high prevalence of carpal tunnel syndrome, its effects on quality of life, and the cost that disease burden generates to health systems make it important to identify the research priorities that will be resolved in clinical trials.

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Test-retest reliability and minimal detectable change scores for the timed "up & go" test, the six-minute walk test, and gait speed in people with Alzheimer disease.

Julie D Ries, John L Echternach, Leah Nof … (2009)

With the increasing incidence of Alzheimer disease (AD), determining the validity and reliability of outcome measures for people with this disease is necessary. The goals of this study were to assess test-retest reliability of data for the Timed "Up & Go" Test (TUG), the Six-Minute Walk Test (6MWT), and gait speed and to calculate minimal detectable change (MDC) scores for each outcome measure. Performance differences between groups with mild to moderate AD and moderately severe to severe AD (as determined by the Functional Assessment Staging [FAST] scale) were studied. This was a prospective, nonexperimental, descriptive methodological study. Background data collected for 51 people with AD included: use of an assistive device, Mini-Mental Status Examination scores, and FAST scale scores. Each participant engaged in 2 test sessions, separated by a 30- to 60-minute rest period, which included 2 TUG trials, 1 6MWT trial, and 2 gait speed trials using a computerized gait assessment system. A specific cuing protocol was followed to achieve optimal performance during test sessions. Test-retest reliability values for the TUG, the 6MWT, and gait speed were high for all participants together and for the mild to moderate AD and moderately severe to severe AD groups separately (intraclass correlation coefficients > or = .973); however, individual variability of performance also was high. Calculated MDC scores at the 90% confidence interval were: TUG=4.09 seconds, 6MWT=33.5 m (110 ft), and gait speed=9.4 cm/s. The 2 groups were significantly different in performance of clinical tests, with the participants who were more cognitively impaired being more physically and functionally impaired. A single researcher for data collection limited sample numbers and prohibited blinding to dementia level. The TUG, the 6MWT, and gait speed are reliable outcome measures for use with people with AD, recognizing that individual variability of performance is high. Minimal detectable change scores at the 90% confidence interval can be used to assess change in performance over time and the impact of treatment.

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The carpal tunnel syndrome. A study of carpal canal pressures.

G Lundborg, T. Hargens, R Gelberman … (1981)

We measured intracarpal canal pressures with the wick catheter in fifteen patients with carpal tunnel syndrome and in twelve control subjects. The mean pressure in the carpal canal was elevated significantly in the patients. When the wrist was in neutral position, the mean pressure was thirty-two millimeters of mercury. With 90 degrees of wrist flexion the pressure increased to ninety-four millimeters of mercury, while with 90 degrees of wrist extension the mean pressure was 110 millimeters of mercury. The pressure in the control subjects with the wrist in neutral position was 2.5 millimeters of mercury; with wrist flexion the pressure rose to thirty-one millimeters of mercury, and with wrist extension it increased to thirty millimeters of mercury. Carpal tunnel release brought about an immediate and sustained reduction in pressure.

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Author and article information

Contributors

César Fernández De Las Peñas: Role: Academic Editor

Journal

Journal ID (nlm-ta): Diagnostics (Basel)

Journal ID (iso-abbrev): Diagnostics (Basel)

Journal ID (publisher-id): diagnostics

Title: Diagnostics

Publisher: MDPI

ISSN (Electronic): 2075-4418

Publication date (Electronic): 09 May 2021

Publication date Collection: May 2021

Volume: 11

Issue: 5

Electronic Location Identifier: 849

Affiliations

[1 ]Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu 300, Taiwan; b96401093@ 123456ntu.edu.tw

[2 ]Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 100, Taiwan; jacy50521@ 123456gmail.com (I.-C.L.); polingkuo@ 123456gmail.com (P.-L.K.)

[3 ]Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei 100, Taiwan; r06945032@ 123456ntu.edu.tw

[4 ]Department of Electrical Engineering, National Taiwan University, Taipei 100, Taiwan

Author notes

[* ]Correspondence: nojred@ 123456gmail.com

Author information

Meng-Ting Lin https://orcid.org/0000-0003-4796-3341

Chueh-Hung Wu https://orcid.org/0000-0002-3979-3541

Article

Publisher ID: diagnostics-11-00849

DOI: 10.3390/diagnostics11050849

PMC ID: 8150286

PubMed ID: 34065073

SO-VID: 3558156e-270e-4ebc-99e6-5aab6470c693

License:

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

Effect of Perineural Injection with Different Dextrose Volumes on Median Nerve Size, Elasticity and Mobility in Hands with Carpal Tunnel Syndrome

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Most cited references 29

Carpal tunnel syndrome: clinical features, diagnosis, and management.

Test-retest reliability and minimal detectable change scores for the timed "up & go" test, the six-minute walk test, and gait speed in people with Alzheimer disease.

The carpal tunnel syndrome. A study of carpal canal pressures.

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