Gökhan ÖZDEMİR, Recep DEMİR, Lütfi ÖZEL, Hızır ULVİ

Karpal tünel sendromunda Novel metoduyla yapılan steroid enjeksiyonunun ağrı şiddeti ve elektrofizyolojik bulgular üzerine etkisi

Amaç: Bu çalışmadaki amacımız Novel metodu ile yapılan lokal steroid enjeksiyon tedavisini hastanın sübjektif şikayetleri ile elektrofizyolojik çalışmalar üzerine olan etkilerinin 3 ay sonra incelenmesidir. Yöntemler: Hafif düzeyde karpal tünel sendromu olan, 5 erkek ve 54 kadın olmak üzere toplam 59 kişide ve 101 elden Novel tekniği ile steroid enjeksiyonu yapıldı. Ağrı şiddetini belirlemek için görsel analog skalası (Visual Analogue Scale) (VAS) uygulandı. VAS ile sinir ileti bulguları enjeksiyon öncesi ve 3 ay sonrası karşılaştırıldı. Bulgular: VAS\'a göre sağ el (n:56) enjeksiyon öncesi ortalama ağrı şiddeti 7.79±1.4 3 ay sonrası 3.29±1.9. Sol el (n:45) enjeksiyon öncesi ortalama ağrı şiddeti 7.71±1.2 3 ay sonrası 3.16±2.0 idi. Enjeksiyon sonrası, her iki elde median motor sinir distal latansı istatistiksel olarak anlamlı bulundu (p

Anahtar Kelimeler:

Karpal tünel sendromu, Novel metod, steroid enjeksiyonu, ağrı şiddeti, sinir ileti çalışmaları

The effect of steroid injection by Novel method in carpal tunnel syndrome on pain severity and electrophysiological findings

Objective: The aim of the present study is to investigate the effects of local steroid injection therapy with the Novel method on subjective patient complaints and electrophysiological investigations at the end of 3 months. Methods: 101 hands of 59 subjects (5 men and 54 women) with mild carpal tunnel syndrome received steroid injection with the Novel technique. Visual Analogue Scale (VAS) was used to determine the severity of pain. Nerve conduction findings obtained prior to and 3 months after the injection were compared using the VAS. Results: According to the VAS, mean pain severity for the right hand (n:56) was 7.79±1.4 before the injection, and 3.29±1.9 at 3 months. Mean pain severity for the left hand (n=45) was 7.71±1.2 before the injection, and 3.16±2.0 at 3 months. Median motor nerve distal latency was statistically significant for both hands after the injection (p

Keywords:

Carpal tunnel syndrome, Novel method, steroid injection, pain severity, nerve conduction studies,

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Dumitru D, Zwarts MJ. Focal peripheral neuropathies. In: Dumitru D, Amato AA, Zwarts MJ (eds). Electrodiag- nostic Medicine. Philadelphia, PA: Hanley and Belfus; 2001:1043-1126.
Bland JD. Carpal tunnel syndrome. BMJ 2007;335:343-346.
Uzkeser H, Karatay S, Alkan Melikoğlu M. Levels of en- docrine hormones and lipids in male patients with carpal tunnel syndrome. Dicle Med J 2011;38:427-431.
Shrivastava N, Szabo RM. Decision making in the manage- ment of entrapment neuropathies of the upper extremity. J Musculoskeletal Med 2008;25:278-289.
Boyer MI. Corticosteroid injection for carpal tunnel syn- drome. J Hand Surg Am 2008;33:1414-1416.
American Association of Electrodiagnostic Medicine, Amer- ican Academy of Neurology, American Academy of Physi- cal Medicine and Rehabilitation. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: sum- mary statement. Muscle Nerve 2001;25:918-922.
Gracely RH: Methods of testing pain mechanisms in nor- mal man, Edit By PD Wall, R Melzack, Textbook of Pain, Churchill Livingstone, Singapore, 1989:257.
Visser LH, Ngo Q, Groeneweg SJM, Brekelmans G. Long term effect of local corticosteroid injection for carpal tunnel syndrome: A relation with electrodiagnostic severity. Clin Neurophysiol 2012;123:838-841.
Jenkins PJ, Duckworth AD, Watts AC, McEachan JE. Cor- ticosteroid injection for carpal tunnel syndrome: a 5-year survivorship analysis. American Association for Hand Sur- gery 2012;7:151-156.
Cartwright MS, White DL, DeMar S, et al. Median nerve changes following steroid injection for carpal tunnel syn- drome. Muscle Nerve 2011;44:25-29.
Hagebeuk EE, DeWeerd AW. Clinical and electrophysi- ological follow-up after local steroid injection in the carpal tunnel syndrome. Clin Neurophysiol 2004;115:1464-1468.
Rükşen S, Öz B, Ölmez N, Memiş A. Comparison of clini- cal effectiveness of corticosteroid phonophoresis and local steroid Injection treatment in carpal tunnel syndrome. Turk J Phys Med Rehab 2011;57:119-123.
Padua L, Padua R, Aprile I, et al. Multiperspective follow- up of untreated carpal tunnel syndrome. A multicenter study. Neurology 2001;56:1459-1466.
Dhong ES, Han SK, Lee BI, Kim WK. Correlation of elec- trodiagnostic findings with subjective symptoms in carpal tunnel syndrome. Ann Plast Surg 2000;45:127-131.
Dudley Porras AF, Rojo Alaminos P, Vinuales JI, Ruiz Vil- lamanan MA. Value of electrodiagnostic tests in carpal tun- nel syndrome. J Hand Surg 2000;25:361-365.
Mondelli M, Reale F, Sicurelli F, Padua L. Relationship be- tween the selfadministered Boston questionnaire and elec- trophysiological findings in follow-up of surgically-treated carpal tunnel syndrome. J Hand Surg (Br) 2000;25:128- 134.
Demirici D, Kutluhan S, Koyuncuoglu HR, et al. Compari- son of open carpal tunnel release and local steroid treatment outcomes in idiopathic carpal tunnel syndrome. Rheumatol Int 2002;22:33-37.
Habib GS, Badarny S, Rawashdeh H. A novel approach of local corticosteroid injection for the treatment of carpal tun- nel syndrome. Clin Rheumatol 2006;25:338-340.
Badarny S, Rawashdeh H, Meer J, et al. Repeated electro- physiologic studies in patients with carpal tunnel syndrome following local corticosteroid injection using a novel ap- proach. Isr Med Assoc J 2011;13:25-28.