Ultrasound-guided local corticosteroid injection for carpal tunnel syndrome: A meta-analysis of randomized controlled trials

Abstract

Objective: This meta-analysis aimed to compare the efficacy and safety of ultrasound-guided (US-guided) versus landmark-guided (LM-guided) local corticosteroid injection for carpal tunnel syndrome (CTS). Methods: Database including Pubmed, Embase, and Cochrane Library were searched to identify relevant randomized controlled trials (RCTs). The outcomes mainly included Boston Carpal Tunnel Questionnaire (BCTQ): Symptom Severity Scale (BCTQs), Functional Status Scale (BCTQf); and electrophysiological indexes: distal motor latency (DML), sensory distal latency (SDL), compound muscle action potential (CAMP), sensory nerve action potential amplitude (SNAP), and sensory nerve conduction velocity (SNCV). Adverse events were also recorded. Results: Overall, nine RCTs were finally screened out with 469 patients (596 injected hands). Pooled analysis showed that US-guided injection was more effective in BCTQs (SMD, −0.69; 95% CI, −1.08 to −0.31; P = 0.0005), BCTQf (SMD, −0.23; 95% CI, −0.39 to −0.07; P = 0.005), CAMP (MD, 0.64; 95% CI, 0.35−0.94; P < 0.0001) improvement, and a lower rate of adverse events (RR, 0.34; 95% CI, 0.22−0.52; P < 0.00001). Subgroup analysis revealed that the US-guided injection had significantly better CMAP than the LM-guided for the in-plane approach (MD, 0.69; 95% CI, 0.36−1.01; P < 0.0001) but not for the out-plane approach (MD, 0.39; 95% CI, −0.39 to 1.17; P = 0.33). Conclusions: US-guided injection was superior to LM-guided injection in symptom severity, functional status, electrodiagnostic, and adverse events improvement for CTS. To some extent, the in-plane approach yields better results compared with the out-plane process under US guidance.

Commentary: Ultrasound-Guided Triamcinolone Acetonide Hydrodissection for Carpal Tunnel Syndrome: A Randomized Controlled Trial

“…First, the final concentration of triamcinolone in group 1 was 1 mg/mL (10 mg per 10 mL of solution), and for group 2, it was 5 mg/mL (10 mg per 2 mL of solution). Second, the corticosteroids effects on CTS are believed to be due to the anti-inflammation to lessen the intracarpal pressure for symptoms relief; therefore, ultrasound guidance is crucial ( 5 ). If more corticosteroid can remain closer to the inflamed MN, the better outcome it should be.…”

Current diagnosis and management of carpal tunnel syndrome: A review

“…27,[44][45][46] A study conducted in 2021 stated that US-guided injection was better than landmark-guided injection with a higher success rate, and lower side effects for CTS. 47 A study conducted in 2018 compared local steroid injection with night time splinting. It indicated that a single injection of 20 mg methylprednisolone acetate at 6 weeks was more beneficial in alleviating pain and improving function than night wrist splints.…”

Perineural Injection of Mecobalamin Versus Dextrose 5% Against Clinical Changes and Electrophysiological Features of Carpal Tunnel Syndrome Patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

“…In more severe cases, surgery is required to release the carpal ligament that is pressing on the median nerve. [1][2][3] The perineural injection is one option for treating CTS, either with steroids or mecobalamin. Steroids have been shown to be effective in reducing inflammation and pain, but their use is limited due to side effects.…”