A Prospective Study to Assess the Outcome of Steroid Injections and Wrist Splinting for the Treatment of Carpal Tunnel Syndrome

Abstract

Surgery is the definitive treatment for carpal tunnel syndrome. Conservative treatments, such as wrist splinting and steroid injections, are also effective for the relief of carpal tunnel symptoms, but their use remains controversial because they only offer long-term relief in a minority of patients. A prospective study was performed to assess the role of steroid injections combined with wrist splinting for the management of carpal tunnel syndrome. A total of 73 patients with 99 affected hands were studied. Patients presenting with known medical causes or muscle wasting were excluded. Diagnosis was made clinically and electrodiagnostic studies were performed only when equivocal clinical signs were present. Each patient received up to three betamethasone injections into the carpal tunnel and wore a neutral-position wrist splint continuously for 9 weeks. After that period, symptomatic patients received an open carpal tunnel release, and those who remained asymptomatic were followed up regularly for at least 1 year. Patients who relapsed were scheduled for surgery. At a minimum follow-up of 1 year, seven patients (9.6 percent) with 10 affected hands (10.1 percent) remained asymptomatic. This group had a significantly shorter duration of symptoms (2.9 months versus 8.35 months; p = 0.039, Mann-Whitney test) and significantly less sensory change (40 percent versus 72 percent; p = 0.048, Fisher's exact test) at presentation when compared with the group who had surgery. It is concluded that steroid injections and wrist splinting are effective for relief of carpal tunnel syndrome symptoms but have a long-term effect in only 10 percent of patients. Symptom duration of less than 3 months and absence of sensory impairment at presentation were predictive of a lasting response to conservative treatment. It is suggested that selected patients (i.e., with no thenar wasting or obvious underlying cause) presenting with mild to moderate carpal tunnel syndrome receive either a single steroid injection or wear a wrist splint for 3 weeks. This will allow identification of the 10 percent of patients who respond well to conservative therapy and do not need surgery.

Neurolysis of the Median Nerve to the Carpal Canal by the Way Mini-Open: Review of 68 Files at Brazzaville University Hospital

“…His treatment is primarily medical. Neurolysis only occurs after failure of medical treatment and in severe forms [3] [6] [8] [9]. This syndrome is the prerogative of the adult.…”

“…Carpal tunnel infiltrations are often performed for therapeutic purposes [8]. The most common complication of these infiltrations is to prick the median nerve with or without intraneural injection [9]. This very painful accident can lead to a lasting or even definitive sensory deficit.…”

Combination treatment for tunnel neuropathies of the lower extremities

“…Для проверки предположения о наличии компрессии нерва ex juvantibus используют футлярные блокады с местны-ми анестетиками параневрально в точки наибольшей болез-ненности («ловушечный пункт») или предполагаемого сдав-ления, которые находят по анатомическим ориентирам [5,7,21]. Купирование парестезий и боли свидетельствует о том, что диагноз поставлен правильно.…”

“…Радикальным методом лечения большинства тоннельных синдромов является операция -рассечение тканей, сдавли-вающих нерв, и создание оптимальных условий для нервно-го ствола, предупреждающих его травматизацию. Наличие грубых выпадений двигательных и чувствительных функ-ций, быстрое нарастание симптоматики с развитием конт-рактур -абсолютные показания к операции [21,22]. Одна-ко в подавляющем большинстве случаев прибегнуть к опе-рации вынуждает безуспешность консервативного лечения, а не абсолютные показания.…”

“…Самым быстрым и эффективным методом купирова-ния боли, воспаления и отека в «ловушечном пункте», если врач имеет необходимые навыки, являются инъекции ГК непосредственно в каналы или ткани, окружающие нерв [2,3,5,21,22]. ГК оказывают противовоспалительное и про-тивоотечное действие непосредственно в тканях, а также об-ладают ремиелинизирующим эффектом при локальных ау-тоиммунных поражениях периферических нервов.…”