Comparing The Efficacy Of Local Triamcinolone Injection In Carpal Tunnel Syndrome Using Three Different Approaches with or without Ultrasound Guidance
Received 20 April 2019
Accepted for publication 18 September 2019
Published 24 October 2019 Volume 2019:12 Pages 2951—2958
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Katherine Hanlon
Seyed Mansoor Rayegani,1 Seyed Ahmad Raeissadat,2 Mohammad Ahmadi-Dastgerdi,1 Nafise Bavaghar,3 Shahram Rahimi-Dehgolan4
1Physical Medicine and Rehabilitation Research Center, Shohada-E-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 2Clinical Development Research Center of Shahid Modarres Hospital, Physical Medicine and Rehabilitation Department and Research Center, Shahid Beheshti University of Medical Sciences, School of Medicine, Tehran, Iran; 3Department of Nuclear Medicine and Molecular Imaging, Rajaie Cardiovascular, Medical and Research, Iran University of Medical Sciences, School of Medicine, Tehran, Iran; 4Physical Medicine and Rehabilitation Department, IKHC Center, Tehran University of Medical Sciences (TUMS), School of Medicine, Tehran, Iran
Correspondence: Mohammad Ahmadi-Dastgerdi
No. 1998734383, Shahid Modarres Hospital, Kaj Square, Saadat Abad Street, Tehran, Iran
Shahram Rahimi-Dehgolan No. 1419733141, Physical Medicine and Rehabilitation Department, IKHC Center, Keshavarz Blvd, Tehran, Iran
Purpose: The present article has investigated the added value of ultrasound (US) guidance on improving the efficacy of local triamcinolone injection via comparing two US-guided methods versus a conventional landmark-guided approach.
Methods: Eighty-one subjects with mild or moderate CTS were included and randomly assigned into three categories including landmark-guided, conventional US-guided midline approach and US-guided ulnar in-plane method. Primarily, participants in the three groups were relatively similar in terms of demographics and their clinical variables comprising visual analog scale (VAS) for pain, pain-free grip strength (PFGS), Boston CTS questionnaire (BCTQ), EDX parameters, and cross-sectional area (CSA) of median nerve measured by ultrasonography. Ten weeks after injection, the changes of clinical and para-clinical outcomes were reassessed for 76 patients who finished the study.
Results: Our findings showed that all three injection methods were associated with a significant and relatively similar improvement in clinical and electrodiagnostic parameters. The post-injection evaluation showed a statistically significant change in all variables except for symptom severity score (SSS) of BCTQ. The best effect-size values were observed for VAS [56%] and functional severity scale (FSS) of BCTQ [42%], both reported in the US-guided midline group. However, no significant difference was found between the groups regarding their improvement in any of the outcome variables (P value >0.05).
Conclusion: Based on the current data, all three injection methods were effective in improving electrodiagnostic findings and clinical symptoms of CTS. Although all approaches were relatively similar, US-guided midline approach was associated with slightly better outcomes.
Keywords: corticosteroid injection, electrodiagnosis, conservative treatment
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