Efficacy of Combined Ultrasound-Guided Steroid Injection and Splinting in Patients With Carpal Tunnel Syndrome

Wang, Jia‐Chi; Liao, Kwong‐Kum; Lin, Kon‐Ping; Chou, Chen-Liang; Yang, Tsui-Fen; Huang, Yu-Fang; Wang, Kevin A.; Chiu, Jen-Hwey

doi:10.1016/j.apmr.2017.01.018

Cited by 33 publications

(32 citation statements)

References 29 publications

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“…Further, although PRP injection ranked second in effectiveness in terms of functional improvement, the patients in the two included PRP studies [23,29] had additional splinting after the injection. An earlier randomized controlled trial has revealed that splinting combined with corticosteroid injection was superior to corticosteroid injection alone, in terms of functional recovery and symptom relief in CTS [48]. Therefore, it is reasonable to speculate that post-injection splinting contributed to the functional outcome in the PRP group.…”

Section: Discussionmentioning

confidence: 96%

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

et al. 2020

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This network meta-analysis aimed to integrate the available direct and indirect evidence on regenerative injections-including 5% dextrose (D5W) and platelet-rich plasma (PRP)-for the treatment of carpal tunnel syndrome (CTS). Literature reports comparing D5W and PRP injections with non-surgical managements of CTS were systematically reviewed. The main outcome was the standardized mean difference (SMD) of the symptom severity and functional status scales of the Boston Carpal Tunnel Syndrome Questionnaire at three months after injections. Ranking probabilities of the SMD of each treatment were acquired by using simulation. Ten studies with 497 patients and comparing five treatments (D5W, PRP, splinting, corticosteroid, and normal saline) were included. The results of the simulation of rank probabilities showed that D5W injection was likely to be the best treatment, followed by PRP injection, in terms of clinical effectiveness in providing symptom relief. With respect to functional improvement, splinting ranked higher than PRP and D5W injections. Lastly, corticosteroid and saline injections were consistently ranked fourth and fifth in terms of therapeutic effects on symptom severity and functional status. D5W and PRP injections are more effective than splinting and corticosteroid or saline injection for relieving the symptoms of CTS. Compared with splinting, D5W and PRP injections do not provide better functional recovery. More studies investigating the long-term effectiveness of regenerative injections in CTS are needed in the future.Pharmaceuticals 2020, 13, 49 2 of 17 factors of CTS include, but are not limited to, female sex, obesity, diabetes, and hypothyroidism [4,5]. The diagnosis of CTS is traditionally based on electrophysiological tests; however, ultrasonographic nerve cross-sectional area measurements have also recently emerged as useful alternatives [6]. The therapeutic algorism for CTS can be based on symptom severity, findings of electrophysiological tests, and responsiveness to non-surgical therapy. Conservative treatments for mild to moderate CTS include corticosteroid injection [7], splinting [8], and physiotherapy (like therapeutic ultrasound, exercise, and neural mobilization) [9,10]. In patients with moderate to severe symptoms and poor responsiveness to non-operative management, carpal tunnel release (CTR) is indicated [11]. However, the symptoms might persist in 3% to 20% of patients after CTR [12]. In recalcitrant cases, the physicians should consider surgical management, such as revision neuroplasty, neurolysis, and nerve reconstruction [12].Corticosteroids function as potent anti-inflammatory medications and have been widely used as the main injectate for treating CTS. A recent randomized controlled trial that recruited 234 patients with CTS demonstrated that a single corticosteroid injection was better than night splinting in terms of clinical effectiveness at six weeks post-injection [13]. The aforementioned result is consistent with that of a previous systematic review that revealed the s...

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Section: Discussionmentioning

confidence: 96%

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

et al. 2020

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“…Makhlouf et al revealed that the therapeutic effect extended up to 6 months. Recently, Wang et al showed improvement in symptoms, functional recovery, and restored nerve function at 12‐week follow‐up. The discrepancy of the duration of success in the aforementioned studies may arise from differences in assistive guidance, injectate volume, and severity of symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…In the past few decades, corticosteroid was the most used injectate for perineural injection under blind or ultrasound‐guided technique in patients with CTS, with constructive effect . However, Cochrane has demonstrated its short‐term (1 month) effect compared to placebo control .…”

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confidence: 99%

Randomized double‐blinded clinical trial of 5% dextrose versus triamcinolone injection for carpal tunnel syndrome patients

Ke²,

Ho³

et al. 2018

Annals of Neurology

101

148

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“…[ 30 ] Ultrasound can measure the diameter and CSA of the torsion or compression nerve to determine the scope of nerve injury. [ 31 ] In addition, ultrasound can detect the location and length of nerve injury, thus determining the scope of surgical operation. [ 32 ] In the small incision surgery, ultrasound can be of great importance in the choice of incision site.…”

Section: Discussionmentioning

confidence: 99%

Electrophysiological examination and high frequency ultrasonography for diagnosis of radial nerve torsion and compression

Shi

Ding

et al. 2018

Medicine

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This study aims to evaluate the value of electrophysiological examination and high frequency ultrasonography in the differential diagnosis of radial nerve torsion and radial nerve compression.Patients with radial nerve torsion (n = 14) and radial nerve compression (n = 14) were enrolled. The results of neurophysiological and high frequency ultrasonography were compared.Electrophysiological examination and high-frequency ultrasonography had a high diagnostic rate for both diseases with consistent results. Of the 28 patients, 23 were positive for electrophysiological examination, showing decreased amplitude and decreased conduction velocity of radial nerve; however, electrophysiological examination cannot distinguish torsion from compression. A total of 27 cases showed positive in ultrasound examinations among all 28 cases. On ultrasound images, the nerve was thinned at torsion site whereas thickened at the distal ends of torsion. The diameter and cross-sectional area of torsion or compression determined the nerve damage, and ultrasound could locate the nerve injury site and measure the length of the nerve.Electrophysiological examination and high-frequency ultrasonography can diagnose radial neuropathy, with electrophysiological examination reflecting the neurological function, and high-frequency ultrasound differentiating nerve torsion from compression.

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Efficacy of Combined Ultrasound-Guided Steroid Injection and Splinting in Patients With Carpal Tunnel Syndrome

Cited by 33 publications

References 29 publications

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

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

Randomized double‐blinded clinical trial of 5% dextrose versus triamcinolone injection for carpal tunnel syndrome patients

Electrophysiological examination and high frequency ultrasonography for diagnosis of radial nerve torsion and compression

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