Comparison Between Effectiveness of Ultrasound-Guided Corticosteroid Injection Above Versus Below the Median Nerve in Mild to Moderate Carpal Tunnel Syndrome

Babaei-Ghazani, Arash; Nikbakht, Nadere; Forogh, Bijan; Raissi, Gholam Reza; Ahadi, Tannaz; Ebadi, Safoora; Roomizadeh, Peyman; Fadavi, Hamid Reza; Raeissadat, Seyed Ahmad; Eftekharsadat, Bina

doi:10.1097/phm.0000000000000877

Cited by 21 publications

(17 citation statements)

References 20 publications

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“…15 However, due to inconsistent results from published studies, controversy continues about the optimal strategy between short-and long-axis injection for CTS. 12,13,[16][17][18] In our clinical practice, both short-and long-axis injections were effective for HD in patients with CTS. Moreover, we observed that hydrodissecting both the FR and the SSCT seemed to enhance the therapeutic benefits of HD, based on patients' clinical presentations.…”

Section: Resultsmentioning

confidence: 89%

Comparison of short- and long-axis nerve hydrodissection for carpal tunnel syndrome: A prospective randomized, single-blind trial

Chen¹,

Ho²,

Shen³

et al. 2021

Preprint

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Introduction This study is to compare the efficacy of two different methods of nerve hydrodissection (HD), called short- and long-axis injection, for patients with mild-to-moderate carpal tunnel syndrome (CTS). Methods Forty-seven patients with mild-to-moderate CTS were enrolled in a prospective, randomized, single-blinded, controlled trial (6 months follow-up). With ultrasound guidance, patients in both groups (short-axis or long-axis groups) were injected with normal saline (5 mL per session). Assessments were performed before and 2 weeks after the injection, as well as at 1, 3, and 6 months post-intervention. The primary outcome measure was the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) score and secondary outcomes included the cross-sectional area of the median nerve and electrophysiological studies. Results Forty-four patients (21 wrists in the short-axis group and 23 wrists in the long-axis group) completed the study. Compared with the baseline, both groups showed improved BCTQ and cross-sectional area at all follow-up assessments (p<0.05). Moreover, the short-axis group had significant improvements in BCTQ-severity and BCTQ-function 1 month post-injection compared to the long-axis group (p = 0.031 and p = 0.023, respectively). Conclusion Both short- and long-axis HD were effective for patients with mild-to-moderate CTS; however, the short-axis HD conferred relatively better efficacy 1 month after the injection.

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Section: Resultsmentioning

confidence: 89%

Comparison of short- and long-axis nerve hydrodissection for carpal tunnel syndrome: A prospective randomized, single-blind trial

Chen¹,

Ho²,

Shen³

et al. 2021

Preprint

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“…Among similar studies, Babaei-Ghazani et al, compared the clinical effectiveness of ultrasound-guided local triamcinolone injection “above” versus “below” the median nerve in CTS patients 23. They found that all outcome measures such as VAS, Boston questionnaire, EDX and US parameters improved significantly in both groups at 6 weeks, and these improvements were persevered up to 12-week follow-up.…”

Section: Discussionmentioning

confidence: 96%

<p>Comparing The Efficacy Of Local Triamcinolone Injection In Carpal Tunnel Syndrome Using Three Different Approaches with or without Ultrasound Guidance</p>

Rayegani¹,

Raeissadat²,

Ahmadi-Dastgerdi³

et al. 2019

JPR

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PurposeThe present article has investigated the added value of ultrasound (US) guidance on improving the efficacy of local triamcinolone injection via comparing two US-guided methods versus a conventional landmark-guided approach.MethodsEighty-one subjects with mild or moderate CTS were included and randomly assigned into three categories including landmark-guided, conventional US-guided midline approach and US-guided ulnar in-plane method. Primarily, participants in the three groups were relatively similar in terms of demographics and their clinical variables comprising visual analog scale (VAS) for pain, pain-free grip strength (PFGS), Boston CTS questionnaire (BCTQ), EDX parameters, and cross-sectional area (CSA) of median nerve measured by ultrasonography. Ten weeks after injection, the changes of clinical and para-clinical outcomes were reassessed for 76 patients who finished the study.ResultsOur findings showed that all three injection methods were associated with a significant and relatively similar improvement in clinical and electrodiagnostic parameters. The post-injection evaluation showed a statistically significant change in all variables except for symptom severity score (SSS) of BCTQ. The best effect-size values were observed for VAS [56%] and functional severity scale (FSS) of BCTQ [42%], both reported in the US-guided midline group. However, no significant difference was found between the groups regarding their improvement in any of the outcome variables (P value >0.05).ConclusionBased on the current data, all three injection methods were effective in improving electrodiagnostic findings and clinical symptoms of CTS. Although all approaches were relatively similar, US-guided midline approach was associated with slightly better outcomes.

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“…Some studies evaluate different US-guided techniques. Babaei-Ghazani et al 25 compared in-plane ulnar US-guided corticosteroid injection with "above" and "below" the median nerve approaches and concluded that both techniques were effective in symptom relief and functional improvement; as well they observed almost equal change in electrodiagnostic and sonographic parameters. In our study, we used in-plane radial versus the widely used ulnar approach for the carpal tunnel injection.…”

Section: Discussionmentioning

confidence: 99%

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

Babaei-Ghazani¹,

Forogh²,

Raissi³

et al. 2020

JPR

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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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Comparison Between Effectiveness of Ultrasound-Guided Corticosteroid Injection Above Versus Below the Median Nerve in Mild to Moderate Carpal Tunnel Syndrome

Cited by 21 publications

References 20 publications

Comparison of short- and long-axis nerve hydrodissection for carpal tunnel syndrome: A prospective randomized, single-blind trial

Comparison of short- and long-axis nerve hydrodissection for carpal tunnel syndrome: A prospective randomized, single-blind trial

<p>Comparing The Efficacy Of Local Triamcinolone Injection In Carpal Tunnel Syndrome Using Three Different Approaches with or without Ultrasound Guidance</p>

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

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