<p>Ultrasound-Guided Corticosteroid Injection in Carpal Tunnel Syndrome: Comparison Between Radial and Ulnar Approaches</p>

Abstract

Purpose: To compare two common approaches for ultrasonography (US)-guided injection. Patients and Methods: Sixty patients with mild-to-moderate CTS were included in this double-blind randomized controlled trial (RCT). They received a single shot of corticosteroid injection through either the US-guided in-plane approach: radial or ulnar side. Participants were evaluated using Boston Carpal Tunnel Questionnaire (BCTQ) and visual analogue scale (VAS) for pain, as well as electrodiagnosis (EDX) and US parameters before the intervention, and within 12 weeks of follow-up. Results: In both groups, all outcomes, except for the electrodiagnostic measures, significantly improved within the follow-up. Pain-VAS and both subscales of BCTQ questionnaire, as our main subjective outcomes, revealed dramatic improvement, with the largest amount of changes in VAS (70%; comparing to baseline value), and about 37% for both of BQSS and BQFS scales, all indicating superiority of radial to ulnar in-plane approach. During the first follow-up, we did not detect any remarkable preference between the groups in either subjective or electrodiagnostic variables. However, there was a significant difference at next follow-up time-points in terms of VAS for pain and BQFS favoring radial approach (Table 3). Furthermore, US-measured parameters including nerve-circumference and CSA improved only in the radial in-plane group. Conclusion: The current data proved that radial in-plane approach for CTS injection could be at least as effective as the more common ulnar in-plane method. Even the pain-relief effect was longer for the radial in-plane approach. Also, patients' functional status and objective variables all revealed better outcomes via the new approach.

Application of digital infrared thermography for carpal tunnel syndrome evaluation

“…One of the reliable and objective methods for assessing CTS is electrodiagnosis, which reflects the neurophysiological functional status and is useful for grading severity 3 , 4 . Ultrasonography (US) is also widely used because it can quantitatively evaluate swelling of the median nerve and carpal tunnel outlet, and it allows guided administration of the injection through real-time visualization 5 – 7 . Electrodiagnosis, however, can mainly detect pathologies in thick-myelinated fibers; its sensitivity for detecting injuries of thin-unmyelinated fiber is relatively low 8 .…”

Ultrasound-guided carpal tunnel injections

“…Three approaches to carpal tunnel injections can be found in the literature and all of them are performed with a linear transducer of varying frequencies (5-17 MHz). 11,13,14,[26][27][28][29]…”

Value of imaging to guide interventional procedures in rheumatic and musculoskeletal diseases: a systematic literature review informing EULAR points to consider

“…Another study with moderate RoB reported less longterm pain, better function and less swelling of the median nerve after injection of the carpal tunnel from the radial rather than from the ulnar site of the wrist. 78 Furthermore, one retrospective cohort study (high RoB) assessed whether there were differences in safety or efficacy outcomes when the needle was placed in the intraepineurium as compared with the extraepineurium, when performing US-guided hydrodissection and GC injection of the median nerve in CTS. 73 The results for safety and clinical efficacy outcomes like function and symptom severity were comparable between groups, while patients receiving intraepineural injections yielded a higher reduction of perinerve oedema 2 weeks after the intervention as compared with those who underwent extraepineural interventions.…”