Effectiveness of Ultrasound-Guided Carpal Tunnel Injection Using In-Plane Ulnar Approach

Abstract

The objective of this study is to evaluate the degree of symptom improvement and the change of electrophysiological and ultrasonographic findings after sonographically guided local steroid injection using an in-plane ulnar approach in carpal tunnel syndrome (CTS).Seventy-five cases of 44 patients diagnosed with CTS were included and evaluated at baseline and at 4 and 12 weeks after injection. All patients received injection with 40 mg of triamcinolone mixed with 1 mL of 1% lidocaine into the carpal tunnel using an in-plane Ultrasound (US)-guided ulnar approach, out-plane US-guided approach, and blind injection. For clinical evaluation, we used the Boston Carpal Tunnel Questionnaire (BCTQ) and electrophysiological tests. The ultrasonographic findings were also evaluated with regard to cross-sectional area and the flattening ratio of the median nerve.Subjective symptoms measured by BCTQ and median nerve conduction parameters showed significant improvement at 4 weeks in the in-plane ulnar approach group compared with the out-plane ulnar approach and blind injection. This improvement was still observed at 12 weeks. The flattening ratio and cross-sectional area of the median nerve showed a more significant decrease with the in-plane ulnar approach than with the out-plane ulnar approach and blind injection (P < 0.05).US-guided local steroid injection using an in-plane ulnar approach in the CTS may be more effective than out-plane or blind injection.

Comparing the effectiveness of ultrasound-guided versus blind steroid injection in the treatment of severe carpal tunnel syndrome

“…more effective in improving electrodiagnostic and US findings and symptoms than blind injection, and the in-plane ulnar approach was superior to the out-plane approach and blind injections in improving median-toulnar sensory nerve distal latency ratios, CSA, and Boston questionnaire symptom scores (12). In this study, although higher improvement rates for SNAP, SNCV, and CMAP were obtained in the blind-injection group than the USguided group, complete cure was obtained in two patients only in the US-guided group.…”

“…Moreover, US enables visualization of the distribution of the injected substance with little or no patient discomfort (22,23). The in-plane method has some advantages, including visualization of all of the carpal tunnel structures around the nerve, which facilitates an accurate perineural injection (12). Although steroid injections are routinely administered for CTS, direct needle injury of the median nerve is the major complication of these injections.…”

“…Therefore, injection under ultrasound (US) guidance may increase precision and therapeutic outcomes and decrease complication rates. There are only a few studies that have investigated US guidance for injections in CTS, and they generally determined that US-guided injections result in better symptom relief and increased and long-lasting therapeutic effects compared to blind injections (11)(12)(13). Since the studies in this area are limited in number, this study was conducted to compare the effectiveness of USguided injection versus blind injection of corticosteroids in the treatment of severe CTS according to symptom severity, hand function, and electrophysiological parameters.…”

“…A cadaveric study has demonstrated that there is wide variability of injectate distribution following injection (9). Moreover, steroid injections tend to cause complications such as nerve insult, vessel insult, and skin lesions (e.g., color change) (10)(11)(12). Median nerve injury is the most serious complication associated with local steroid injection for CTS (10).…”

Local administration of corticosteroids in treatment of carpal tunnel syndrome

“…Частота повреждения сре-динного нерва при анализе более чем 3000 локальных инъекций составляет около 0,1 % [24]. Тем не менее нередкое описание данного типа осложнений в иссле-дованиях с небольшими выборками позволяет пред-полагать, что такие ситуации встречаются чаще [25].…”