Ultrasound-guided needle release of the transverse carpal ligament with and without corticosteroid injection for the treatment of carpal tunnel syndrome

Abstract

BackgroundTo compare the clinical effectiveness of ultrasound-guided needle release of the transverse carpal ligament (TCL) with and without corticosteroid injection in carpal tunnel syndrome (CTS).MethodsFrom June 2016 to June 2017, 49 CTS patients (50 wrists) were included in this study. Twenty-five wrists were treated with ultrasound-guided needle release of the TCL plus corticosteroid injection (group A), and 25 wrists were treated with single ultrasound-guided needle release of the TCL (group B). The following parameters were assessed and compared including postprocedure results according to relief of symptoms, ultrasound parameters (cross-sectional area of the median nerve at the levels of pisiform, flattening ratio of median nerve at the levels of the hamate bone, and the thicknesses of TCL on the cross-section at the level of the hamate bone), and electrophysiological parameters (distal motor latency and sensory conduction velocity).ResultsGroup A had higher overall excellent and good rate 3 months after the procedure than group B (84 vs 52%, P < 0.05). There were significant differences regarding the above ultrasonic and electrophysiological parameters between the baseline and postprocedure values in both groups (all P < 0.05). There were significant differences regarding the postprocedure values of above ultrasonic and electrophysiological parameters between the two groups (all P < 0.05). No complications such as infection or tendon rupture were noted. No procedures were converted to the open release.ConclusionsBoth techniques are effective in treating CTS. Ultrasound-guided needle release of the TCL with corticosteroid injection had better treatment benefits than single ultrasound-guided needle release of the TCL in treating CTS.

Ultrasound-guided carpal tunnel injections

“… 14 When lying supine, the arm is abducted to 90° with the elbow extended. 11 , 15 , 16 In both positions the forearm is supinated and the wrist is in a 15–35° dorsiflexion position. 11 , 15 , 16 Careful US examination is important for injection planning.…”

“… 11 , 15 , 16 In both positions the forearm is supinated and the wrist is in a 15–35° dorsiflexion position. 11 , 15 , 16 Careful US examination is important for injection planning. The wrist is examined with a linear probe along the carpal tunnel and special attention is given to the MN anatomy (size, position, aberrant variants) and the course of blood vessels.…”

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

“…1 The other conservative interventions include night splinting, local and oral corticosteroids, or other medications such as non-steroidal antiinflammatory drugs. 8,9 One of the most effective methods to alleviate symptoms is corticosteroid injection which has been widely used to achieve a rapid pain relief. 10 This intervention has been conventionally performed with the guidance of local anatomic landmarks, sometimes called the "blind" technique.…”

“…Moreover, physician cannot ensure the accurate placement of the injection needle inside the carpal tunnel using this technique. 9 US-guided injection can verify the needle position within the carpal tunnel and consequently ensure a successful injection which can lead to a lower risk of median nerve injury. 11 US provides a real-time image of the nerve, the carpal tunnel, and the surrounding structures.…”

“…Prior literature have compared US-guided injections against the blind technique and have demonstrated that US-guided ones are associated with higher effectiveness. 9 Although numerous injection approaches using US-guidance have been described, there is not enough evidence favoring one to others. 11 Generally, there are two methods of US-probe placement in the wrist: short axis (transverse view) and long-axis (longitudinal view).…”