Usefulness of Ultrasonography to Predict Response to Injection Therapy in Carpal Tunnel Syndrome

Abstract

ObjectiveTo verify the feasibility of initial parameters of ultrasonography or electromyography for the prediction of effect after steroid injection therapy in a carpal tunnel syndrome (CTS) patient.MethodWe recruited individuals with clinical and electrodiagnostic evidence of CTS. Results from the Boston self-assessment questionnaire, median motor and sensory nerve conduction studies, and median nerve ultrasonography were evaluated at baseline, 1 month, and 6 months after injection. Evaluation of median nerve ultrasonography parameters included measurements taken at the maximal swelling point (MS), 2 cm proximal from MS (2MS), and 12 cm proximal from MS (12MS), and its ratio (MS/12MS, 2MS/12MS) was calculated. The correlation between improvement of the symptom score after treatment and baseline parameters was estimated.ResultsFourteen individuals (14 women, mean age 53.8 years) with 22 affected wrists were enrolled. After steroid injection therapy, clinical and electromyographic parameters showed significant improvements at 1 month or 6 months after injection, and ultrasonographic parameters showed significant changes in maximal area and area ratio (MS/12MS) of the median nerve. Symptom score improvement showed a positive correlation in the initial 2MS and ratio of 2MS/12MS after 6 months (p<0.05).ConclusionMost of the improvements occurred during the first month after injection and lasted up to 6 months. The initial median nerve swelling and its ratio may be a useful predictor of response after steroid injection.

Idiopathic Carpal Tunnel Syndrome: Evaluation of the Depth of the Carpal Tunnel by Ultrasonography

“…All ultrasonographic examinations were performed by the same examiner to avoid interobserver bias. During US measurements, the probe just touched the skin to avoid induction of artifacts (Jeong et al 2011). A perpendicular angle of the probe was maintained in all examinations (Jeong et al 2011).…”

“…During US measurements, the probe just touched the skin to avoid induction of artifacts (Jeong et al 2011). A perpendicular angle of the probe was maintained in all examinations (Jeong et al 2011). Data are expressed as the arithmetical mean 6 standard deviation or median (range) depending on normality as determined with the KolmogorovSmirnov test.…”

Role of Ultrasound to Monitor Patients With Carpal Tunnel Syndrome Treated With a Local Corticosteroid

“…Although there are varying results in the literature comparing the electrophysiologic and US parameters, in this study, electrophysiologic parameters scored higher than the HRUS parameters . Although there have been many studies investigating HRUS changes in monitoring treatment, only a few have studied HRUS and electrophysiology together . Even though statistically not significant, improvement was noted in the median nerve CSA at 1 and 3 months.…”

Dupuytren’s disease digital radius IV right hand and carpal tunnel syndrome on ipsilateral hand

“…Differential diagnosis in the carpal tunnel syndrome is made with: proximal nerve damage ; hypertrophic arthritis ; compression of the median nerve in the round pronator muscle ; neuritis associated with local corticosteroid therapy ; progressive muscular atrophy ; ulnar neuropathy [1][2][3][4][5][20][21][22][23][24][25][26][27][28][29].…”

“…The carpal tunnel syndrome is a peripheral neuropathy with the incarceration of the median nerve at the ARC level, expressed clinically by sensory and motor disturbances in the distribution territory of the median nerve, which cause functional limitations of daily activities of the patient. After the failure of the nonsurgical treatment or the appearance of the motor deficit, is established the open or endoscopic surgical treatment with the release of the median nerve [20][21][22][23][24][25][26][27][28][29].…”