Comparing The Efficacy Of Local Triamcinolone Injection In Carpal Tunnel Syndrome Using Three Different Approaches with or without Ultrasound Guidance

• Main Authors: Rayegani SM, Raeissadat SA, Ahmadi-Dastgerdi M, Bavaghar N, Rahimi-Dehgolan S
• Format: Article
• Language: English
• Published: Dove Medical Press 2019-10-01
• Series: Journal of Pain Research
• Subjects: Corticosteroid Injection; Electrodiagnosis; Conservative Treatment
• Online Access: https://www.dovepress.com/comparing-the-efficacy-of-local-triamcinolone-injection-in-carpal-tunn-peer-reviewed-article-JPR

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, IranCorrespondence: Mohammad Ahmadi-Dastgerdi No. 1998734383, Shahid Modarres Hospital, Kaj Square, Saadat Abad Street, Tehran, IranTel/fax [phone]Email [e-mail] Shahram Rahimi-Dehgolan No. 1419733141, Physical Medicine and Rehabilitation Department, IKHC Center, Keshavarz Blvd, Tehran, IranTel/fax [phone]Email [e-mail]: 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