Eda GÜRÇAY, Özgür Zeliha KARAAHMET, Aytül ÇAKCI, Azize SERÇE, Zeynep KIRAÇ ÜNAL, Murat KARA

Comparing the effectiveness of ultrasound-guided versus blind steroid injection in the treatment of severe carpal tunnel syndrome

Background/aim: This study aimed to compare the effectiveness of ultrasound (US)-guided injection versus blind injection of corticosteroids in the treatment of carpal tunnel syndrome (CTS). Materials and methods: This prospective, randomized clinical trial included patients with severe CTS based on clinical and electrophysiological criteria. The patients were evaluated for clinical and electrophysiological parameters at baseline and 4 weeks after treatment. Symptom severity and hand function were assessed by the Boston questionnaire. The patients underwent blind injection or US-guided injection. Results: When compared with baseline, both groups showed significant improvement in Boston questionnaire scores and all electrophysiological parameters. Significant differences were observed between the groups for clinical parameters (Boston Symptom Severity Scale: P = 0.007; Functional Status Scale: P < 0.001) in favor of the US-guided group. Conclusion: This study demonstrated that both US-guided and blind injections were effective in reducing symptoms and improving hand function. US-guided injections may yield more effective clinical results in the short-term than blind injections in the treatment of patients with severe CTS.

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1. Katz JN, Simmons BP. Clinical practice. Carpal tunnel syndrome. N Engl J Med 2002; 346: 1807-1812.
2. Jillapalli D, Shefner JM. Electrodiagnosis in common mononeuropathies and plexopathies. Semin Neurol 2005; 25: 196-203.
3. Amirfeyz R, Gozzard C, Leslie IJ. Hand elevation test for assessment of carpal tunnel syndrome. J Hand Surg Br 2005; 30: 361-364.
4. Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev 2007; 18: CD001554.
5. Karadas O, Tok F, Akarsu S, Tekin L, Balaban B. Triamcinolone acetonide vs procaine hydrochloride injection in the management of carpal tunnel syndrome: randomized placebocontrolled study. J Rehabil Med 2012; 44: 60-64.
6. Gurcay AG, Karaahmet OZ, Gurcan O, Kazanci A, Karsli PB, Umay EK, Acer S, Unlu E. Comparison of short-term clinical and electrophysiological outcomes of local steroid injection and surgical decompression in the treatment of carpal tunnel syndrome. Turk Neurosurg 2017; 27: 447-452.
7. Wilson JK, Sevier TL. A review of treatment for carpal tunnel syndrome. Disab Rehabil 2003; 25: 113-119.
8. Kim DH, Jang JE, Park BK. Anatomical basis of ulnar approach in carpal tunnel injection. Pain Physician 2013; 16: 191-198.
9. Ozturk K, Esenyel CZ, Sonmez M, Esenyel M, Kahraman S, Senel B. Comparison of carpal tunnel injection techniques: a cadaver study. Scand J Plast Reconstr Surg Hand Surg 2008; 42: 300-304.
10. Racasan O, Dubert T. The safest location for steroid injection in the treatment of carpal tunnel syndrome. J Hand Surg Br 2005; 30: 412-414.
11. Üstün N, Tok F, Yagız AE, Kizil N, Korkmaz I, Karazincir S, Okuyucu E, Turhanoglu D. Ultrasound-guided vs. blind steroid injections in carpal tunnel syndrome: a single-blind randomized prospective study. Am J Phys Med Rehabil 2013; 92: 999-1004.
12. Lee JY, Park Y, Park KD, Lee JK, Lim OK. Effectiveness of ultrasound-guided carpal tunnel injection using in-plane ulnar approach: a prospective, randomized, single-blinded study. Medicine (Baltimore) 2014; 93: 350.
13. Makhlouf T, Emil NS, Sibbitt WL Jr, Fields RA, Bankhurst AD. Outcomes and cost-effectiveness of carpal tunnel injections using sonographic needle guidance. Clin Rheumatol 2014; 33: 849-858.
14. World Medical Association. World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. J Int Bioethique 2004; 15: 124-129.
15. Oh SJ. Clinical Electromyography: Nerve Conduction Studies. 2nd ed. Baltimore, MD, USA: Williams and Wilkins; 1993. pp. 84-105.
16. Kara M, Özçakar L, De Muynck M, Tok F, Vanderstraeten G. Musculoskeletal ultrasound for peripheral nerve lesions. Eur J Phys Rehabil Med 2012; 48: 665-674.
17. Kersten P, Küçükdeveci AA, Tennant A. The use of the visual analogue scale (VAS) in rehabilitation outcomes. J Rehabil Med 2012; 44: 609-610.
18. Levine DW, Sõmmons B, Korõs MJ, Daltroy LH, Hohl GG, Fossel AN, Katz JN. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am 1996; 75: 1585- 1592.
19. Sezgin M, Incel NA, Serhan S, Camdeviren H, As I, Erdoğan C. Assessment of symptom severity and functional status in patients with carpal tunnel syndrome: reliability and functionality of the Turkish version of the Boston Questionnaire. Disabil Rehabil 2006; 28: 1281-1285.
20. Evers S, Bryan AJ, Sanders TL, Selles RW, Gelfman R, Amadio PC. The effectiveness of ultrasound-guided compared to blind steroid injections in the treatment of carpal tunnel syndrome. Arthritis Care Res 2017; 69: 1060-1065.
21. Ozçakar L, Tok F, De Muynck M, Vanderstraeten G. Musculoskeletal ultrasonography in physical and rehabilitation medicine. J Rehabil Med 2012; 44: 310-318.
22. Tagliafico A, Bodner G, Rosenberg I, Palmieri F, Garello I, Altafini L, Martinoli C. Peripheral nerves: ultrasound-guided interventional procedures. Semin Musculoskelet Radiol 2010; 14: 559-566.
23. Özçakar L, Onat ŞŞ, Gürçay E, Kara M. Are blind injections ethical or historical?: Think twice with ultrasound. Am J Phys Med Rehabil 2016; 95: 158-160.
24. Kim HJ, Park SH. Median nerve injuries caused by carpal tunnel injections. Korean J Pain 2014; 27: 112-117.