Comparison Between Distal and Proximal Approaches for Local Corticosteroid Injection in Carpal Tunnel Syndrome Management: A Randomized Controlled Trial

Abstract

Background: The present, open-labeled study aimed to compare the distal approach (DA) for local corticosteroid injection (LCI) with the conventional proximal approach (PA) in alleviating the symptom and improving the electrodiagnostic parameters of the patients with carpal tunnel syndrome (CTS). Methods: A total of 60 participants with nonsevere CTS were included in the present randomized controlled trial (RCT), of which 29 and 31 were assigned to the DA and PA groups, respectively. Each group received a single, landmark-guided injection of local methylprednisolone. The participants were assessed preintervention and 3 months later using the measures of visual analog scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), hand grip strength, and nerve conduction study (NCS). Results: Following a 3-month follow-up, both groups had significant improvements in VAS, both functional and severity subscales of BCTQ, hand grip strength, and some electrodiagnostic parameters (all P-values < .05). Moreover, the DA group had a significantly lower procedure duration than the PA group (9.80 ± 1.12 vs. 27.61 ± 1.77; P < .001). Conclusions: LCI using the DA should be considered a feasible, safe, and effective therapeutic method in patients with mild to moderate CTS. It had a shorter procedure duration than conventional PA, while their clinical and electrophysiological results were similar.

Comparison of Distal and Proximal Local Steroid Injection for Carpal Tunnel Syndrome: a Systematic Review and Meta-analysis of Randomized Controlled Trials

“…Pooled Analysis of BCTQ BCTQ was available in three studies [10,22,23], including 121 patients in the DA group and 124 patients in the PA group. The summarized estimate of effect size indicated that there was no significant difference in BCTQs (SMD 0.11; 95% CI -0.14 to 0.36; P = 0.39; Fig.…”

“…Pooled Analysis of VAS VAS was described in three papers [22][23][24], with 65 patients in the DA group and 68 patients in the PA group. The pooled estimate of effect size showed that the VAS did not differ significantly between the two groups (MD -0.34; 95% CI -0.81 to 0.13; P = 0.15; Fig.…”

“…The random sequence generation was low risk in all studies [10,19,[22][23][24], and the illustration of allocation concealment was unclear for three trials [19,23,24]. The blinding of researcher and outcome assessment was evaluated as ''high risk'' for one study [22] and ''unclear risk'' for three trials [19,23,24]. There was no attrition or reporting bias for all studies and other biases could not be accurately determined.…”

“…Nair et al [10] found that the pain perceived during the injections was higher in the DA, while Habib et al [19] reported a completely opposite result. Two studies [22,23] showed that the procedure duration in the DA group was significantly shorter than the PA group, while the other two [10,19] concluded no statistically significant. To provide scientific reference for clinical decision making, we have conducted a systematic review and meta-analysis to consolidate existing evidence from the available literature comparing the two injection methods for LSI in patients with CTS, in terms of symptom severity, functional status, and electrodiagnostic outcomes.…”

“…Badarny et al [21] found that the rate response of electrophysiological studies was similar to the results of previous studies using the PA. An active debate is currently ongoing in the literature whether the DA results in better treatment outcomes than the conventional PA. This indeterminacy has been magnified by inconsistent results obtained from various clinical trials comparing the effectiveness of distal versus proximal local steroid injection in patients with CTS [10,19,[22][23][24]. Nair et al [10] found that the pain perceived during the injections was higher in the DA, while Habib et al [19] reported a completely opposite result.…”