The effect of steroid injection by Novel method in carpal tunnel syndrome on pain severity and electrophysiological findings
Amaç: Bu çalışmadaki amacımız Novel metodu ile yapı- lan 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: VASa 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
Karpal tünel sendromunda Novel metoduyla yapılan steroid enjeksiyonunun ağrı şiddeti ve elektrofizyolojik bulgular üzerine etkisi
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<0.001). Median motor velocity was statistically non-significant in both hands after the injection. After the injection, median sensory distal latency, amplitude and velocity were statistically significant for both hands. Conclusion: The present study showed the efficacy of local steroid injection therapy on subjective complaints and electrophysiological findings in mild carpal tunnel syndrome. Because the improvement is greater in the non-dominant hand compared to the other, splints should be used to keep the hand in neutral position and hand rest should be employed in addition to the local injection.
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- 1. 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.
- 2. Bland JD. Carpal tunnel syndrome. BMJ 2007;335:343-346.
- 3. Uzkeser H, Karatay S, Alkan Melikoğlu M. Levels of endocrine hormones and lipids in male patients with carpal tunnel syndrome. Dicle Med J 2011;38:427-431.
- 4. Shrivastava N, Szabo RM. Decision making in the management of entrapment neuropathies of the upper extremity. J Musculoskeletal Med 2008;25:278-289.
- 5. Boyer MI. Corticosteroid injection for carpal tunnel syndrome. J Hand Surg Am 2008;33:1414-1416.
- 6. American Association of Electrodiagnostic Medicine, American Academy of Neurology, American Academy of Physical Medicine and Rehabilitation. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement. Muscle Nerve 2001;25:918-922.
- 7. Gracely RH: Methods of testing pain mechanisms in normal man, Edit By PD Wall, R Melzack, Textbook of Pain, Churchill Livingstone, Singapore, 1989:257.
- 8. 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.
- 9. Jenkins PJ, Duckworth AD, Watts AC, McEachan JE. Corticosteroid injection for carpal tunnel syndrome: a 5-year survivorship analysis. American Association for Hand Surgery 2012;7:151-156.
- 10. Cartwright MS, White DL, DeMar S, et al. Median nerve changes following steroid injection for carpal tunnel syndrome. Muscle Nerve 2011;44:25-29.
- 11. Hagebeuk EE, DeWeerd AW. Clinical and electrophysiological follow-up after local steroid injection in the carpal tunnel syndrome. Clin Neurophysiol 2004;115:1464-1468.
- 12. Rükşen S, Öz B, Ölmez N, Memiş A. Comparison of clinical effectiveness of corticosteroid phonophoresis and local steroid Injection treatment in carpal tunnel syndrome. Turk J Phys Med Rehab 2011;57:119-123.
- 13. Padua L, Padua R, Aprile I, et al. Multiperspective followup of untreated carpal tunnel syndrome. A multicenter study. Neurology 2001;56:1459-1466.
- 14. Dhong ES, Han SK, Lee BI, Kim WK. Correlation of electrodiagnostic findings with subjective symptoms in carpal tunnel syndrome. Ann Plast Surg 2000;45:127-131.
- 15. Dudley Porras AF, Rojo Alaminos P, Vinuales JI, Ruiz Villamanan MA. Value of electrodiagnostic tests in carpal tunnel syndrome. J Hand Surg 2000;25:361-365.
- 16. Mondelli M, Reale F, Sicurelli F, Padua L. Relationship between the selfadministered Boston questionnaire and electrophysiological findings in follow-up of surgically-treated carpal tunnel syndrome. J Hand Surg (Br) 2000;25:128- 134.
- 17. Demirici D, Kutluhan S, Koyuncuoglu HR, et al. Comparison of open carpal tunnel release and local steroid treatment outcomes in idiopathic carpal tunnel syndrome. Rheumatol Int 2002;22:33-37.
- 18. Habib GS, Badarny S, Rawashdeh H. A novel approach of local corticosteroid injection for the treatment of carpal tunnel syndrome. Clin Rheumatol 2006;25:338-340.
- 19. Badarny S, Rawashdeh H, Meer J, et al. Repeated electrophysiologic studies in patients with carpal tunnel syndrome following local corticosteroid injection using a novel approach. Isr Med Assoc J 2011;13:25-28.