Carpal Tunnel Injection: With or Without Ultrasound Guidance?

Goldberg, Gary; Wollstein, Ronit; Chimes, Gary P.

doi:10.1016/j.pmrj.2011.09.004

Cited by 8 publications

(2 citation statements)

References 31 publications

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“…1,5,32 However, the superiority of ultrasound-guided injection over landmark-guided injection has always been limited and inconclusive. 6,33 The ultrasound’s real-time imaging capability provides a clear visualization of adjacent tissues (e.g. tendon, ligament, nerve, blood vessel) while placing the needle into the carpal tunnel, avoiding damage to surrounding structures.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided local corticosteroid injection for carpal tunnel syndrome: A meta-analysis of randomized controlled trials

et al. 2021

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Objective: This meta-analysis aimed to compare the efficacy and safety of ultrasound-guided (US-guided) versus landmark-guided (LM-guided) local corticosteroid injection for carpal tunnel syndrome (CTS). Methods: Database including Pubmed, Embase, and Cochrane Library were searched to identify relevant randomized controlled trials (RCTs). The outcomes mainly included Boston Carpal Tunnel Questionnaire (BCTQ): Symptom Severity Scale (BCTQs), Functional Status Scale (BCTQf); and electrophysiological indexes: distal motor latency (DML), sensory distal latency (SDL), compound muscle action potential (CAMP), sensory nerve action potential amplitude (SNAP), and sensory nerve conduction velocity (SNCV). Adverse events were also recorded. Results: Overall, nine RCTs were finally screened out with 469 patients (596 injected hands). Pooled analysis showed that US-guided injection was more effective in BCTQs (SMD, −0.69; 95% CI, −1.08 to −0.31; P = 0.0005), BCTQf (SMD, −0.23; 95% CI, −0.39 to −0.07; P = 0.005), CAMP (MD, 0.64; 95% CI, 0.35−0.94; P < 0.0001) improvement, and a lower rate of adverse events (RR, 0.34; 95% CI, 0.22−0.52; P < 0.00001). Subgroup analysis revealed that the US-guided injection had significantly better CMAP than the LM-guided for the in-plane approach (MD, 0.69; 95% CI, 0.36−1.01; P < 0.0001) but not for the out-plane approach (MD, 0.39; 95% CI, −0.39 to 1.17; P = 0.33). Conclusions: US-guided injection was superior to LM-guided injection in symptom severity, functional status, electrodiagnostic, and adverse events improvement for CTS. To some extent, the in-plane approach yields better results compared with the out-plane process under US guidance.

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Section: Discussionmentioning

confidence: 99%

Ultrasound-guided local corticosteroid injection for carpal tunnel syndrome: A meta-analysis of randomized controlled trials

et al. 2021

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“…In addition, ultrasound can yield anatomic information and can detect structural pathology important for both diagnosis and therapy planning. Ultrasound can also serve as a guidance technology to ensure the safety and accuracy of focal injection of corticosteroids for the treatment of CTS [66]. Recently, McDonagh et al [67] have proposed a “new paradigm” in which PN‐USI of the median nerve could be effectively “used as an alternative” to EDx for the diagnosis of FMMW in patients with suspected CTS because it has a sensitivity and specificity similar to those of EDx but higher patient acceptability.…”

Section: Discussionmentioning

confidence: 99%