Ultrasound‐Guided Hydrodissection With Corticosteroid Injection in the Treatment of Carpal Tunnel Syndrome

Abstract

ObjectivesCorticosteroid injections can provide (temporary) relief in patients with mild to moderate carpal tunnel syndrome (CTS). Hydrodissection as part of an injection has been associated with positive clinical outcomes but data for CTS so far has been scarce. This study is designed to assess patient tolerance and secondarily provide pilot data on the added effect of hydrodissection.MethodsTwenty CTS patients were randomized to an ultrasound‐guided betamethasone injection with hydrodissection (5 mL) or without (2 mL). Patient tolerance was assessed directly after intervention and patient‐reported outcome after 4 and 24 weeks. Intra‐group data were compared using Wilcoxon Signed Rank and inter‐group with Wilcoxon rank‐sum tests.ResultsTolerance and pain scores did not differ between the two groups. Symptom scores decreased in both groups, but to a lesser extent in the hydrodissection group with a mean difference of −0.8 versus −1.5 in the control group at 4 weeks (P = .02). At 6 months, this difference was no longer present (P = .81). No statistically significant differences were found between the hydrodissection and control groups in the function or pain scores at follow‐up at either time point.ConclusionAfter injection, both symptomatic and functional scores improved, but the hydrodissected group did not show additional improvement. Data presented can be used to support larger studies to assess the value of hydrodissection in CTS management.

Ultrasound-guided carpal tunnel injections

“…43 However, Schrier et al were unable to prove the superiority of a 5 ml versus 2 ml in-jection of corticosteroids and LA. 28 It is speculated that larger injected volumes (> 5 ml) yield better results due to the conjoined effect of hydrodissection and better injection distribution. 30,43 With hydrodissection, adhesiolysis can be achieved by separating TCL from the MN and enabling normal tendon gliding.…”

“…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]…”

Ultrasound-Guided Triamcinolone Acetonide Hydrodissection for Carpal Tunnel Syndrome: A Randomized Controlled Trial

“…Through our literature search from PubMed and EMBASE, we could only find one other paper with similar methodology. The small RCT was designed to investigate the influence of corticosteroid hydrodissection on CTS ( 27 ). Schrier et al enrolled 20 patients randomly assigned to either ultrasound-guided hydrodissection using 1 mL of betamethasone (6 mg), 1 ml of 1% lidocaine, and 3 mL saline or injection only with 1 mL of betamethasone (6 mg) and 1 mL of 1% lidocaine ( 27 ).…”

“…The small RCT was designed to investigate the influence of corticosteroid hydrodissection on CTS ( 27 ). Schrier et al enrolled 20 patients randomly assigned to either ultrasound-guided hydrodissection using 1 mL of betamethasone (6 mg), 1 ml of 1% lidocaine, and 3 mL saline or injection only with 1 mL of betamethasone (6 mg) and 1 mL of 1% lidocaine ( 27 ). The results revealed no significant differences in the visual analog scale of pain or BCTQ scores between the groups at 24 weeks after the intervention.…”

“…The sample size was estimated in an antecedent pilot study investigating betamethasone injection for CTS ( 27 ). A standardized mean difference of 0.3 was assumed between different therapeutic arms, with a standard deviation of 0.4, an alpha level (α) of 0.05, and a power (β) of 80%.…”