Novel Motor-Sparing Ultrasound-Guided Neural Injection in Severe Carpal Tunnel Syndrome: A Comparison of Four Injectates

Abstract

Nerve hydrodissection uses fluid injection under pressure to selectively separate nerves from areas of suspected entrapment; this procedure is increasingly viewed as potentially useful in treating carpal tunnel syndrome (CTS). The usage of normal saline (NS), 5% dextrose water (D5W), platelet-rich plasma (PRP), and hyaluronic acid (HA) as primary injectates for hydrodissection without an anesthetic can limit anesthetic-related toxicity and preserve the motor functions of the median nerve. Here, we describe a novel motor-sparing neural injection and compare the effect of these four injectates for severe CTS. We retrospectively reviewed the outcomes of 61 severe CTS cases after a single neural injection with NS, D5W, PRP, or HA. Outcomes were evaluated on the 1st and 6th months postinjection, including the Boston Carpal Tunnel Questionnaire (BCTQ) scores and the nerve cross-sectional area (CSA). The results revealed that PRP, D5W, and HA were more efficient than NS at all measured time points ( p < 0.05 ), except for CSA at the 1st month between the NS and D5W groups. Single-injections of PRP and D5W seemed more effective than that of HA within 6 months postinjection for symptom and functional improvement (6th-month BCTQ-symptom, D5W vs. HA, p = 0.047 ; 1st-month BCTQ-symptom, PRP vs. HA, p = 0.018 ; 1st- and 6th-month BCTQ-function, D5W vs. HA, p = 0.002 and 0.016, respectively; 1st-month BCTQ-function, PRP vs. HA, p < 0.001 ). For reducing CSA, PRP and HA seemed more effective than D5W ( HA > PRP > D 5 W on the 1st month and HA vs. D5W, p = 0.001 ; PRP > HA > D 5 W on the 6th month and PRP vs. D5W, p = 0.012 ).

Safety and Efficacy of Ultrasound-Guided Perineural Hydrodissection as a Minimally Invasive Treatment in Carpal Tunnel Syndrome: A Systematic Review

“…After removing review articles, unpublished studies, meta-analyses, case studies, practical guidelines, and books (n = 776,065), the full text of the remaining 150 articles was assessed for eligibility. Ultimately, 15 research articles were included in the review (Figure 2) [21,[34][35][36][37][38][39][40][41][42][43][44][45][46][47].…”

“…Santoso et al administered a corticosteroid injection in one group of 15 patients and dextrose water (D5W) in another group of 15 patients, with a total of 30 patients injected [35]. D5W was also used as the principal type of injection in six studies to treat CTS [21,35,36,[40][41][42]. As previously mentioned by Santoso et al, Li et al evaluated 185 patients with CTS after D5W injection [41].…”

“…Chao and colleagues treated 36 patients with persistent or recurrent CTS after primary surgery using D5W [42]. Wu and coworkers compared 16 patients treated with D5W to three groups of 15 patients each who were treated with NS, HA, and PRP, respectively [21]. Additionally, two studies evaluated the efficacy of PRP as an injection therapy for CTS [21,45].…”

“…This US-guided technique not only facilitates the mechanical release and decompression of the entrapped MN but also alleviates pain, improves symptoms, and promotes recovery in patients [19,20]. The decompression mechanism of US-guided HD is linked to the mechanical separation of the nerve from the surrounding soft tissues caused by the fluid flushing, resulting in a lower pressure on the nerve fascicles [21]. Furthermore, a diminishing pressure on the nervi nervorum, which constitute the intrinsic innervation of the nerve sheaths, produces a lesser stimulation of nociceptors and mechanoceptors, resulting in pain relief [22][23][24].…”

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

“…Even with correct needle insertion and localization, patients with CTS are prone to injury owing to edema of the median nerve [12]. In this situation, ultrasound-guided injection is gradually applied for accurate localization and acquires favorable outcomes [13][14][15][16][17]. However, landmark-guided injection still seems to be one of the most available management procedures, attributed to good effectiveness, more convenience, and lower cost [18].…”