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      Ultrasound-Guided Corticosteroid Injection in Carpal Tunnel Syndrome: Comparison Between Radial and Ulnar Approaches

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          Abstract

          Purpose

          To compare two common approaches for ultrasonography (US)-guided injection.

          Patients and Methods

          Sixty patients with mild-to-moderate CTS were included in this double-blind randomized controlled trial (RCT). They received a single shot of corticosteroid injection through either the US-guided in-plane approach: radial or ulnar side. Participants were evaluated using Boston Carpal Tunnel Questionnaire (BCTQ) and visual analogue scale (VAS) for pain, as well as electrodiagnosis (EDX) and US parameters before the intervention, and within 12 weeks of follow-up.

          Results

          In both groups, all outcomes, except for the electrodiagnostic measures, significantly improved within the follow-up. Pain-VAS and both subscales of BCTQ questionnaire, as our main subjective outcomes, revealed dramatic improvement, with the largest amount of changes in VAS (70%; comparing to baseline value), and about 37% for both of BQSS and BQFS scales, all indicating superiority of radial to ulnar in-plane approach. During the first follow-up, we did not detect any remarkable preference between the groups in either subjective or electrodiagnostic variables. However, there was a significant difference at next follow-up time-points in terms of VAS for pain and BQFS favoring radial approach (Table 3). Furthermore, US-measured parameters including nerve-circumference and CSA improved only in the radial in-plane group.

          Conclusion

          The current data proved that radial in-plane approach for CTS injection could be at least as effective as the more common ulnar in-plane method. Even the pain-relief effect was longer for the radial in-plane approach. Also, patients’ functional status and objective variables all revealed better outcomes via the new approach.

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          Most cited references 22

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

          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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            A systematic review of the psychometric properties of the Boston Carpal Tunnel Questionnaire

            Background The Boston Carpal Tunnel Questionnaire (BCTQ) is a disease-specific measure of self-reported symptom severity and functional status. It is frequently used in the reporting of outcomes from trials into interventions for carpal tunnel syndrome. We conducted a systematic review of published studies on the psychometric properties of the BCTQ to determine the level of evidence on the instrument's validity, reliability and responsiveness to date. Methods A search of the databases Medline, CINAHL, AMED and PsychInfo was conducted to retrieve studies which investigated one or more of the psychometric properties of the BCTQ. Data abstraction was undertaken by the first two authors. Results Ten studies were retrieved which met the inclusion criteria. One study evaluated face and content validity (43 patients) eight studies assessed construct validity (932 patients), four studies tested reliability (126 patients) and nine studies assessed responsiveness (986 patients). Interpretability was evaluated in one study and acceptability in eight studies (978 patients). Conclusion The BCTQ is a standardised, patient-based outcome measure of symptom severity and functional status in patients with carpal tunnel syndrome. The evidence base of the psychometric properties indicates that the BCTQ is a valid, reliable, responsive and acceptable instrument and should be included as a primary outcome measures in future CTS trials.
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              • Article: not found

              Ultrasound-guided vs. blind steroid injections in carpal tunnel syndrome: A single-blind randomized prospective study.

              The aim of this study was to compare the efficacy and the safety of ultrasound (US)-guided vs. blind steroid injections in patients with carpal tunnel syndrome (CTS).
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                JPR
                jpainres
                Journal of Pain Research
                Dove
                1178-7090
                26 June 2020
                2020
                : 13
                : 1569-1578
                Affiliations
                [1 ]Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, Iran University of Medical Sciences (IUMS) , Tehran, Iran
                [2 ]Physical Medicine and Rehabilitation Research Center, Department of Physical Medicine and Rehabilitation, Tabriz University of Medical Sciences , Tabriz, Iran
                [3 ]Physical Medicine and Rehabilitation Department, IKHC Center, Tehran University of Medical Sciences (TUMS) , Tehran, Iran
                Author notes
                Correspondence: Shahram Rahimi-Dehgolan Physical Medicine and Rehabilitation Department, IKHC Center, Tehran University of Medical Sciences (TUMS) , Tehran, Iran Email shahram.rahimi.dehgolan@gmail.com
                Katayoun Moradi Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, Iran University of Medical Sciences (IUMS) , Tehran, Iran Email katayoun-moradi69@gmail.com
                Article
                248600
                10.2147/JPR.S248600
                7326201
                32617017
                © 2020 Babaei-Ghazani et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 3, Tables: 3, References: 25, Pages: 10
                Categories
                Original Research

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