Local corticosteroid injection versus placebo for carpal tunnel syndrome

Ashworth, Nigel; Bland, Jeremy D.P.; Chapman, Kristine; Tardif, Gaétan S.; Albarqouni, Loai; Nagendran, Arjuna

doi:10.1002/14651858.cd015148

Cited by 9 publications

(11 citation statements)

References 107 publications

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“…The serious adverse event rate of post-injection severe pain or a sympathetic reaction ranges from 0.3% to 0.5%, and the rate of mild adverse events including mild pain and swelling range from 9% to 65%. 21 Though the individual risk of harm is low, the large volume of carpal tunnel injections performed in facilities offering these services accumulates significant potential harm of which there is an opportunity to relieve a great portion with simple and effective adjustments. To minimize these risks and maximize the chance of success, it is critical that the patient and provider are positioned optimally.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Comfort and Patient Preference of Common and a Novel Position for Ultrasound‐Guided Carpal Tunnel Injections

Balser,

Schwanz,

Wheelock

et al. 2024

J of Ultrasound Medicine

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ObjectivesThis study compared levels of discomfort among three positions for ultrasound‐guided carpal tunnel injections (USCTI) to potentially facilitate and improve the procedure's tolerability in treating carpal tunnel syndrome (CTS).MethodsAmbulatory Veterans referred for electromyography (EMG) evaluation of CTS were eligible for the study; a total of 30 participants were evaluated. Participants were asked to hold three different positions: 1) Hypersupination, 2) Airplane, and 3) TSA. Participants rated their pain level, ease of performing/holding each position, exacerbation of underlying symptoms, and position preference. Results were analyzed with two‐way repeated measures ANOVA.ResultsHypersupination was determined to be the least preferred and most painful position to hold, demonstrating a statistically significant increase in the Numeric Rating Scale score for pain during the procedure compared with Airplane and TSA, which were not significantly different from one another. Pre‐procedure neck, shoulder, elbow, and wrist pain were not significantly associated with intra‐procedure pain.ConclusionsWhen performing USCTI, patient comfort can be optimized by avoiding Hypersupination. Utilizing the Airplane or TSA positions may provide similar access for ulnar approach injections while inducing lower levels of discomfort. Clinical space, resources, patient mobility, and laterality of procedures may further guide one's selection among the positions.

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Section: Discussionmentioning

confidence: 99%

Comparison of Comfort and Patient Preference of Common and a Novel Position for Ultrasound‐Guided Carpal Tunnel Injections

Balser,

Schwanz,

Wheelock

et al. 2024

J of Ultrasound Medicine

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“…This review looks at the efficacy of steroid injection compared with placebo injection or no treatment at all. 3 The authors found 14 trials suitable for inclusion, and the majority of trials used for their quantitative analysis had low risk of bias. Moderate-certainty evidence showed improvement of symptoms favouring steroid injection at three months and up to six months.…”

Section: Local Corticosteroid Injection Versus Placebo For Carpal Tun...mentioning

confidence: 99%

Cochrane Corner

Das

2023

Bone &Amp; Joint 360

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“…Carpal tunnel syndrome (CTS) is the most common form of compressive neuropathy that develops due to the compression of the median nerve in the constrained space of the carpal tunnel. It is typically a chronic and progressive condition, with an incidence of approximately 1%−3% per year[ 1 ]. The co-occurrence of CTS and motor dysfunction caused by gout, which has been reported as a cause of CTS in 0.6% of cases, is extremely rare in clinical practice[ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Bilateral carpal tunnel syndrome and motor dysfunction caused by gout and type 2 diabetes: A case report

Zhang¹,

Rong²,

Li³

et al. 2023

World J Clin Cases

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BACKGROUND Carpal tunnel syndrome (CTS) has been associated with gout and type 2 diabetes mellitus (T2DM). However, due to insufficient clinical understanding of gout-related CTS and reliance on the diagnostic importance of elevated serum uric acid levels, such cases are prone to missed diagnosis, misdiagnosis, and delayed treatment. In addition, the effect of T2DM on gout - induced carpal tunnel syndrome has not been reported. CASE SUMMARY Herein, we present an unusual case of CTS and motor dysfunction caused by miliary tophaceous gout and T2DM. The patient presented to the hand and foot clinic with paresthesia of the fingers of both hands, especially at night. The patient was diagnosed with type 2 diabetes a month ago. Ultrasonography revealed bilateral transverse carpal ligament thickening with median nerve compression during hospitalization. The patient was successfully treated with carpal tunnel decompression and tendon release. The postoperative pathological examination revealed typical gout nodules. This case suggests that the presence of T2DM could accelerate tophi formation and worsen CTS symptoms, although no definitive proof in this regard has been described previously. CONCLUSION Tophi formation may most likely cause the co-occurrence of CTS and flexor dysfunction in gout and incipient diabetes patients.

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Local corticosteroid injection versus placebo for carpal tunnel syndrome

Cited by 9 publications

References 107 publications

Comparison of Comfort and Patient Preference of Common and a Novel Position for Ultrasound‐Guided Carpal Tunnel Injections

Comparison of Comfort and Patient Preference of Common and a Novel Position for Ultrasound‐Guided Carpal Tunnel Injections

Cochrane Corner

Bilateral carpal tunnel syndrome and motor dysfunction caused by gout and type 2 diabetes: A case report

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