Comparison of the Clinical Effectiveness of Ultrasound-Guided Corticosteroid Injection with and without Needle Release of the Transverse Carpal Ligament in Carpal Tunnel Syndrome

Abstract

Background: To compare the clinical effectiveness of ultrasound-guided corticosteroid injection with and without needle release of the transverse carpal ligament (TCL) in carpal tunnel syndrome (CTS). Methods: Between May 2014 and June 2016, 52 patients (56 wrists) with CTS were included in this study. Among these patients, 28 wrists were treated with ultrasound-guided corticosteroid injection plus needle release of the TCL (group A) and 28 wrists were treated with a single ultrasound-guided corticosteroids injection (group B). The following parameters were assessed and compared including postoperative results of procedure based on relief of symptoms, electrophysiological parameters (distal motor latency, sensory conduction velocity, and sensory nerve action potential of median nerve), and ultrasound parameters (anteroposterior diameter and cross-sectional area of the median nerve at the levels of pisiform and hamate bone, and the thicknesses of TCL on the cross-section at the level of hamate bone). Results: The overall excellent and good rate regarding the postoperative results of procedure based on the relief of symptoms at 1 month postoperatively was 82.1% in group A and 46.4% in group B (p = 0.004). There was significant difference in the above electrophysiological and ultrasound parameters between the preoperative and postoperative values in both groups (all p < 0.05). Furthermore, a significant difference was also observed in the postoperative values of the above-mentioned electrophysiological and ultrasound parameters in the 2 groups (all p < 0.05). Conclusions: Both approaches had treatment benefit in CTS. Ultrasound-guided corticosteroid injection in combination with needle release of the TCL is superior to the single ultrasound-guided corticosteroids injection.

Diacutaneous Fibrolysis Intervention in Patients with Mild to Moderate Carpal Tunnel Syndrome May Avoid Severe Cases in Elderly: A Randomized Controlled Trial

“…Other studies aimed to analyze the effects of conservative treatments, such as taping, splint, or ultrasounds, did not demonstrate significant improvements in CSA of the median nerve [ 42 , 49 ]. Previous studies reported improvements after a surgical intervention or corticosteroid infiltration on CSA assessment [ 54 , 55 ]. It is important to consider the possible adverse effects derived from these interventions.…”

Percutaneous Ultrasound-Guided Techniques for Carpal Tunnel Release: A Descriptive Review

“…No SR comparing PUSG techniques of CTR with any other intervention were found. Only 5of the 30 studies reviewed here describing 4 different techniques were RCT [11][12][13][14][15]; a further 3 studies were NoRCT [10,16,17]; and 22 were NoC .…”

“…Three studies by two groups [15][16][17] undertook steroid injection in the same surgical act as FR section. Section direction: anterograde Incision direction: not applicable Entry point: palmar, 5 mm distal to the SAPA, distal edge of the TCL division determined sonographically in the "duck's beak" described by Rojo Manaute et al (38)a previously reported sonographic zone was defined as the space between the median nerve and the closest ulnar vascular structure.…”

Ultrasound‐guided treatment of peripheral entrapment mononeuropathies

“…34 Mechanical hydrodissection may relieve these adhesions 46 and is far easier to perform using an in-plane transverse approach. In addition to the injection, operators can repeatedly fenestrate or "release" the transverse carpal ligament with a needle, 17,47 or perform a minimally invasive release with a specialized surgical instrument. 18,19,48 Ulnar Neuropathy at the Elbow (Cubital Tunnel Syndrome).…”