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Ultrasound-Guided Corticosteroid Injection in Carpal Tunnel Syndrome: Comparison Between Radial and Ulnar Approaches

Authors Babaei-Ghazani A, Forogh B, Raissi GR, Ahadi T, Eftekharsadat B, Yousefi N, Rahimi-Dehgolan S, Moradi K

Received 6 February 2020

Accepted for publication 8 June 2020

Published 26 June 2020 Volume 2020:13 Pages 1569—1578

DOI https://doi.org/10.2147/JPR.S248600

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Michael Schatman


Arash Babaei-Ghazani,1 Bijan Forogh,1 Gholam Reza Raissi,1 Tannaz Ahadi,1 Bina Eftekharsadat,2 Naseh Yousefi,1 Shahram Rahimi-Dehgolan,3 Katayoun Moradi1

1Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, Iran University of Medical Sciences (IUMS), Tehran, Iran; 2Physical Medicine and Rehabilitation Research Center, Department of Physical Medicine and Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran; 3Physical Medicine and Rehabilitation Department, IKHC Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran

Correspondence: Shahram Rahimi-Dehgolan
Physical Medicine and Rehabilitation Department, IKHC Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
Email shahram.rahimi.dehgolan@gmail.com
Katayoun Moradi
Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, Iran University of Medical Sciences (IUMS), Tehran, Iran
Email katayoun-moradi69@gmail.com

Purpose: To compare two common approaches for ultrasonography (US)-guided injection.
Patients and Methods: Sixty patients with mild-to-moderate CTS were included in this double-blind randomized controlled trial (RCT). They received a single shot of corticosteroid injection through either the US-guided in-plane approach: radial or ulnar side. Participants were evaluated using Boston Carpal Tunnel Questionnaire (BCTQ) and visual analogue scale (VAS) for pain, as well as electrodiagnosis (EDX) and US parameters before the intervention, and within 12 weeks of follow-up.
Results: In both groups, all outcomes, except for the electrodiagnostic measures, significantly improved within the follow-up. Pain-VAS and both subscales of BCTQ questionnaire, as our main subjective outcomes, revealed dramatic improvement, with the largest amount of changes in VAS (70%; comparing to baseline value), and about 37% for both of BQSS and BQFS scales, all indicating superiority of radial to ulnar in-plane approach. During the first follow-up, we did not detect any remarkable preference between the groups in either subjective or electrodiagnostic variables. However, there was a significant difference at next follow-up time-points in terms of VAS for pain and BQFS favoring radial approach (Table 3). Furthermore, US-measured parameters including nerve-circumference and CSA improved only in the radial in-plane group.
Conclusion: The current data proved that radial in-plane approach for CTS injection could be at least as effective as the more common ulnar in-plane method. Even the pain-relief effect was longer for the radial in-plane approach. Also, patients’ functional status and objective variables all revealed better outcomes via the new approach.

Keywords: electromyography, corticosteroid injection, Boston Carpal Tunnel Questionnaire, BCTQ, carpal tunnel syndrome, CTS

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