Efficacy of Ultrasound Guided Corticosteroid Injection in Carpal Tunnel Syndrome

Abstract

BACKGROUND : Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome. The etiology can be hereditary, repetitive movements of the wrist in mechanical workers, injury to the wrist, pregnancy, obesity, metabolic disorders, auto immune conditions such as diabetes mellitus, rheumatoid arthritis and in elderly population. Females are affected more than males. A lot of treatment options are available for carpal tunnel syndrome. Corticosteroid injections are very effective in mild to moderate carpal tunnel syndrome on short and in some cases on long term basis.
 OBJECTIVES:To evaluate the efficacy and clinical outcomes of ultrasound guided corticosteroid injection for treatment of carpal tunnel syndrome.
 STUDY SETTING: Department of Orthopedic surgery Services Hospital Lahore .
 STUDY DESIGN: Cross sectional study.
 STUDY DURATION: From December 2018 to December 2019 
 METHODOLOGY: This prospective cross sectional study was carried out from Dec 2018 – Dec 2019 on OPD basis. A total number of 80 patients were included in the study. There were 40 males and 40 females in our study. Each patient was injected triamcinolone 40 mg with 2 % xylocaine. After the injection every patient was followed at 6 weeks, 3 months and at 6 months.
 At each follow up these patients were assessed by Phalen test, Tinel sign, Boston carpal tunnel syndrome severity score, functional assessment scale, electrophysiological studies and nerve conduction study.
 RESULTS : Our study included 80 patients with 40 males and 40 females. 40 female patients were housewives, 25 male patients were manual workers and remaining 15 patients were computer operator. 30 patients had mild symptoms of carpal tunnel syndrome, 35 had moderate while the remaining 15 patients had severe symptoms of carpal tunnel syndrome. All these patients were having symptoms for the last 6 – 12 weeks which did not improve with the conservative management. These patients were having symptoms of numbness and tingling at the initial presentation. Phalen test was positive in 95 % (76 patients) patients while Tinel test was positive in 80 % patients ( 64 patients ) at the initial presentation . 
 Boston’s severity symptom score was 35.34 +/- 3.59 and functional status scale was 25.43 + 5.82 (At the initial presentation) in all patients. Following corticosteroid injection at 06 weeks the symptoms severity score was 21+/-3.32 ( mean ) and at 03 months 18.80 + 3.41 ( mean ) in 72 patients while 8 patients did not respond to corticosteroid injection while the functional status scale 17.62 +- 5.01 and 13.45 +- 4.2 at 03 months .
 Electrophysiological study was also improved after 06 weeks and after 03 months
 CONCLUSION : Corticosteroid injections are very effective regarding the outcomes on short term basis . However , they are effective in small number of patients on long term basis