A Bayesian network meta-analysis: Comparing the clinical effectiveness of local corticosteroid injections using different treatment strategies for carpal tunnel syndrome

Abstract

BackgroundLocal corticosteroid injections are commonly used to improve the short-term symptomatic severity and the functional status of the hands affected by carpal tunnel syndrome. We conducted a systematic review and Bayesian network-meta-analysis to compare the clinical effectiveness of local corticosteroid injections using different injection approaches.MethodsElectronic literature in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Web of Science, and other sources were searched to identify clinical studies comparing different injection approaches with each other or placebo for carpal tunnel syndrome. Two review authors conducted selection of studies, data extraction, and assessment of risk of bias independently. Random-effects models were used to conduct the pairwise meta-analysis and the Bayesian network meta-analysis.ResultsOverall, 10 studies with 633 patients were included in the systematic review. Among the injection approaches, local corticosteroid injections using the ultrasound-guided in-plane injection (Ulnar-I) approach was the best treatment strategy for clinical response (median OR versus placebo 128.30, 95 % CrI 9.76 to 2299.00), change in symptom severity scale (median MD versus placebo −1.16, 95 % CrI −1.95 to −0.38) , and change in functional status scale (median MD versus placebo −0.74, 95 % CrI −2.00 to 0.52) at short-term follow-up period in the network meta-analysis. Local corticosteroid injections using other injection approaches were better than placebo for clinical response (for the PI approach, median OR versus placebo 8.85, 95 % CrI 3.00 to 33.15; for the DI approach, median OR versus placebo 7.00, 95 % CrI 0.53 to 118.80) , change in symptom severity scale (for the Ulnar-O approach, median MD versus placebo −0.78, 95 % CrI −1.43 to −0.16; for the PI approach, median MD versus placebo −0.58, 95 % CrI −0.95 to −0.22), and change in functional status scale (for the Ulnar-O approach, median MD versus placebo −0.63, 95 % CrI −1.67 to 0.43; for the PI approach, median MD versus placebo −0.46, 95 % CrI −1.11 to 0.21) at short-term follow-up period. The quality of studies is good.ConclusionsAccording to our analyses, the ultrasound-guided in-plane injection (Ulnar-I) approach was the most effective treatment among the injection approaches for carpal tunnel syndrome.

Regenerative Injections Including 5% Dextrose and Platelet-Rich Plasma for the Treatment of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis

“…In 2007, a systematic review [14] including 671 participants from 12 studies concluded that corticosteroid injection provided short-term symptom relief in contrast to placebo injection. In 2015, a network meta-analysis [35] with 633 patients from 10 studies compared the effectiveness of corticosteroid injections, using different injection approaches. Their analysis indicated that the ultrasound-guided in-plane injection method through the ulnar aspect of the wrist was the best approach in CTS treatment.…”

Comparison of the Clinical Effectiveness of Ultrasound-Guided Corticosteroid Injection with and without Needle Release of the Transverse Carpal Ligament in Carpal Tunnel Syndrome

“…The basis for the application of this treatment is the ability of corticosteroids to reduce swelling, thereby improving the spatial relation between the carpal tunnel and the median nerve and tendons. Some scholars demonstrated that the injection of corticosteroids into the common flexor sheath and flexor pollicis longus tendon sheath can effectively relieve pain of CTS patients, improve functional impairment, and delay the need for surgery [6,17,18,19,20]. Advancements in ultrasonography allow the visualization of the structures of the carpal tunnel, including the median nerve, flexor tendons, and the TCL as well as the structures at risk, including the ulnar artery and the proximal palmar arch.…”

Local administration of corticosteroids in treatment of carpal tunnel syndrome

“…Нервно-мышечные Б О Л Е З Н И Neuromuscular DISEASES клинических шкал в краткосрочном периоде наблю-дения [34]. Таким образом, локальное введение КС при СЗК под УЗ-контролем методом in plane позволя-ет выполнить процедуру более точно, достоверно увеличивает эффективность лечения и снижает риск осложнений.…”