Injections for treatment of carpal tunnel syndrome: A narrative review of the literature

Cage, Emily S.; Beyer, Julia; Ebraheim, Nabil A.

doi:10.1016/j.jor.2023.02.011

Cited by 7 publications

(5 citation statements)

References 46 publications

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“…[12] The proper indication for CI in patients with CTS includes mild symptoms, short symptom duration of <1-year, normal sensibility, normal thenar strength and mass, and minimal changes at electrodiagnostic changes. [13] Among several risk factors for CTS, older age, especially in patients over 80 years, was the most significantly related factor to performing CI in CTS. These results could be explained, at least in part, by the fact that nonoperative treatment was preferred for elderly patients traditionally due to their age and lower demand for using their hands than younger patients.…”

Section: Discussionmentioning

confidence: 99%

Association of carpal tunnel syndrome risk factors with treatment modality selection focusing on corticosteroid injection and surgery: A nationwide population-based study

Doh,

Kim,

Kim

et al. 2024

Medicine

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Several studies have revealed the risk factors for carpal tunnel syndrome (CTS). However, no studies have evaluated the influence of these risk factors on the selection of treatment modalities for CTS. This study aimed to determine the influence of CTS risk factors on the selection of CTS treatment modalities with a focus on corticosteroid injection (CI) and surgery. We conducted a retrospective cohort study of patients aged ≥20 years with newly diagnosed CTS in the Korean health insurance review and assessment service between 2010 and 2019. We evaluated the demographic information, the existence of CTS risk factors, and the applied treatment modalities for CTS, including CI and operation. The CTS risk factors include age, sex, diabetes mellitus, osteoarthritis of the hand or wrist, rheumatoid arthritis, hypothyroidism, gout, chronic kidney disease (CKD) on dialysis, antiestrogen or aromatase inhibitor medication, and a history of distal radius fracture (DRF). Multivariable logistic regression analyses were conducted. Age over 80 years was the most significantly associated factor for the selection of CI in CTS (odd ratio [OR], 2.149; 95% confidence interval [CI], 2.092 to 2.209; P < .001). Among underlying diseases or medications, CKD on dialysis (OR, 4.001; 95% CI, 3.819–4.193; P < .001) was the most significant associated factor for the selection of operation for CTS, followed by a history of DRF (OR, 1.803; 95% CI, 1.749–1.860; P < .001). Old age was the most significantly related factor for selecting CI. Among underlying diseases or medications, CKD on dialysis and the history of DRF were the most significantly related factors for selecting operative treatment. For these patients, clinicians should proactively consider an operation to reduce the long-term discomfort and economic burdens.

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Section: Discussionmentioning

confidence: 99%

Association of carpal tunnel syndrome risk factors with treatment modality selection focusing on corticosteroid injection and surgery: A nationwide population-based study

Doh,

Kim,

Kim

et al. 2024

Medicine

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“…Moreover, some patients may be receiving injection‐based treatment with corticosteroids in other body regions, thus limiting the amount of steroid that could be given at each target and/or deciding not to treat certain pain regions if the steroid maximum has already been reached. Finally, the recent history of corticosteroid use may be contraindicated in patients who are planned for surgery, and thus, steroid injection may not be a feasible treatment option in the interim 22 . This is especially relevant for healthcare jurisdictions where there is limited/delayed access to surgical care.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, the recent history of corticosteroid use may be contraindicated in patients who are planned for surgery, and thus, steroid injection may not be a feasible treatment option in the interim. 22 This is especially relevant for healthcare jurisdictions where there is limited/delayed access to surgical care.…”

Section: Mechanisms Of Prf In Ctsmentioning

confidence: 99%

A narrative review of pulsed radiofrequency for the treatment of carpal tunnel syndrome

Gupta,

Vance,

Bansal

et al. 2023

Pain Practice

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ObjectiveCarpal tunnel syndrome (CTS), which is the most common peripheral nerve entrapment syndrome, can commonly persist despite conservative treatment modalities such as wrist splinting or medications. Pulsed radiofrequency represents a minimally invasive pain intervention technique to alleviate pain. The literature was reviewed to establish the effectiveness of PRF therapy for CTS.Study DesignThis is a narrative review of relevant articles on the effectiveness of PRF for CTS.MethodFour databases, MEDLINE, Cochrane Central Register of Controlled Trials, Embase, OVID Emcare, and Web of Science, were systematically searched. 804 records were screened, and the reference lists of eligible articles were examined. For this review, eight extracted studies were narratively explored.ResultsOne case report, three retrospective cohorts, one observational prospective study, and three randomized‐controlled trials were included. PRF likely provides both an analgesic and functional benefit in patients with mild to severe CTS, and it also shows benefit as an adjunct to carpal tunnel release surgery. Long‐term data is limited. It also appears likely that steroid injection may represent a comparable treatment modality to PRF, and there have been positive results when these modalities are used together. Notably, all studies differed in their methodology, making direct comparisons between studies challenging.ConclusionsThe evidence for PRF in the treatment of CTS, across the range of spectrum of severity or peri‐operative to CTS surgery, appears favorable and avoids known side effects of steroid injections. Potential mechanisms for PRF and future directions for research are explored.

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“…In patients with CTS, conservative treatments should be tried first and then surgical treatment methods should be applied if the patient does not benefit (Ziyal et al, 1999;Karjalanen et al, 2022;Cage et al, 2023;Mao et al, 2023). Surgically, it is aimed to decompress the median nerve by cutting the carpal ligament over the median nerve, which results in clinically significant improvement (Szabo and Steinberg, 1994;Ziyal et al, 1999).…”

Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of 48 Patients Reoperated for Carpal Tunnel Syndrome

Kesılmez

Yuksel

2023

Black Sea Journal of Health Science

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Purpose: Carpal tunnel syndrome (CTS) is a condition in which the median nerve is compressed between the transverse ligament and the carpal bones. There are various techniques used in the surgical treatment of CTS. The present study aimed to investigate the reasons for reoperation by examining the reoperated cases diagnosed with CTS. Materials and Methods: Patients who underwent surgery for CTS at Kahramanmaraş Sütçü İmam University Department of Neurosurgery between January 1, 2015 and September 1, 2022 were evaluated retrospectively. Patients who underwent two or more operations with the same diagnosis were included in the study, while those operated for the first time due to CTS and with missing data were excluded. The included patients were analyzed in terms of gender, age, occupation, side of the surgery, presence of systemic diseases causing CTS such as diabetes mellitus (DM), number of the operations they underwent, time until the next operation, surgical technique, and medical branch that performed the surgery (orthopedics, neurosurgery, or plastic surgery). Findings: Forty-eight patients who met the study criteria were evaluated. Out of the 48 reoperated patients, 14 were male and 34 were female. Eighteen patients had been operated using the mini-incision open method, while 22 had undergone laparoscopic surgery, including 14 patients with biportal endoscopic surgery, and eight with uniportal endoscopic surgery. Out of the 48 patients, 31 (64.6%), 11 (22.9%), and six patients were first operated by orthopedic and traumatology physicians, plastic and reconstructive surgeons, and neurosurgeons, respectively. Conclusion: The use of open surgical technique is the gold standard in CTS and complete incision of the transverse ligament provides complete decompression of the median nerve. We believe that decompression with closed or small incisions due to aesthetic concerns may not be sufficient and may increase the risk of complications.

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Injections for treatment of carpal tunnel syndrome: A narrative review of the literature

Cited by 7 publications

References 46 publications

Association of carpal tunnel syndrome risk factors with treatment modality selection focusing on corticosteroid injection and surgery: A nationwide population-based study

Association of carpal tunnel syndrome risk factors with treatment modality selection focusing on corticosteroid injection and surgery: A nationwide population-based study

A narrative review of pulsed radiofrequency for the treatment of carpal tunnel syndrome

Retrospective Analysis of 48 Patients Reoperated for Carpal Tunnel Syndrome

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