Different doses of steroid injection in elderly patients with carpal tunnel syndrome: a triple-blind, randomized, controlled trial

Abstract

BackgroundCarpal tunnel syndrome (CTS) is commonly seen in elderly populations, in part due to increased presence of predisposing comorbidities as well as physiological changes. We aimed at comparing the effectiveness of different doses of steroid using the ultrasound-guided hydrodissection method in elderly patients with CTS.MethodsWe conducted a prospective, triple-blind, randomized, controlled trial in elderly patients with CTS. Patients were allocated to one of three groups by simplified randomization. Groups I–III received 80 mg triamcinolone (2 mL) and 1 mL of 2% lidocaine; 40 mg triamcinolone (1 mL), 1 mL of 2% lidocaine, and 1 mL normal saline; and 1 mL of 2% lidocaine and 2 mL normal saline, respectively to make up to 3 mL volume. A wrist splint was then applied for support. Outcome measures included the visual analog scale (VAS) and the Boston Carpal Tunnel Questionnaire, and median motor and sensory nerve conduction and its sonographic inlet cross-sectional area were used as objective measures. All data were recorded at baseline and 2, 12, and 24 weeks after injection. The investigators, patients, and statistician were blinded to the treatment assignment.ResultsIn total, 161 patients were recruited without statistically significant demographic differences between the three groups. There were no statistically significant differences between groups in any outcome, with the exception of the median distal motor latency, which was greater in Group II at all three follow-up visits, and significant baseline VAS difference between Groups I and III.ConclusionHydrodissection with lidocaine and normal saline is as effective as hydrodissection with low- and high-dose steroid medication in elderly patients with CTS in this study, but further studies with matched baseline measures and also a sham group are suggested for definitive recommendation.

<p>The comparison of the effectiveness between different doses of local methylprednisolone injection versus triamcinolone in Carpal Tunnel Syndrome: a double-blind clinical trial</p>

“…In the control group, only 1 mL of 2% lidocaine and 2 mL of NS were administered. The authors found no remarkably significant difference between the two groups; then, they concluded that hydrodissection is more important than anti-inflammatory effects of corticosteroids 13. However, because of lidocaine injection in all the groups and other nonspecific benefits of participants for being in an RCT, this effect might not be so “pure”, as the authors have said.…”

“…Some authors have compared the efficacy and safety of popular corticosteroids at different dosages in CTS patients 13–15. O’Gradaigh and Merry compared the outcomes of local injection of long- and short-acting corticosteroids at different dosages.…”

“…Previously, only few studies have compared the efficacy of local injection of different substances in patients with CTS 13–18. Corticosteroids, especially methylprednisolone and triamcinolone, are among the most prevalent medications used for local injection in patients with CTS 13–15. The therapeutic mechanism of local corticosteroid injection (CSI) has been speculated via a probable suppression of inflammation and a subsequent decompression of the median nerve.…”

Volume Matters in Ultrasound-Guided Perineural Dextrose Injection for Carpal Tunnel Syndrome: A Randomized, Double-Blinded, Three-Arm Trial

“…One cadaver study showed decreased gliding resistance of the nerve in the carpal tunnel after hydrodissection (Evers et al, 2018). Two clinical RCTs further showed positive effects of hydrodissection on pain, function and CSA (Roghani et al, 2018;Wu et al, 2019). Our study adopted an identical injection drug (5% dextrose) to eliminate confounding bias of dextrose.…”

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

“…Some of these conservative options are oral medications like non-steroidal anti-inflammatory drugs (NSAIDs), resting wrist splint, physical agent modalities, and local injections including corticosteroid and platelet-rich plasma (PRP) 7–11. Local corticosteroid injection has been approved as one of the most common conservative therapies which are still the best choice for rapid symptom relief 12–15. The injection could be performed through multiple approaches.…”