Efficacy of Ultrasound-Guided Hydrodissection in Carpal Tunnel Syndrome
Condition: Musculoskeletal Diseases; Median Nerve Disease; Carpal Tunnel Syndrome; Ultrasound-Guided Injection
MeSH terms: Musculoskeletal Diseases; Carpal Tunnel Syndrome; Nervous System Diseases; Median Neuropathy; Syndrome
Study type: Interventional

Summary: 
      The aim of our study is to determine the effectiveness of US-guided hydrodissection of the
      median nerve in different contents and volumes in patients diagnosed with mild to moderate
      carpal tunnel syndrome.
    

Detailed description: 
      Carpal tunnel syndrome is the most common form of entrapment neuropathies. Anatomically, the
      roof of the carpal tunnel consists of carpal bones, it is located under the transverse carpal
      ligament, and there are 9 tendon packs of the forearm flexors and the median nerve.
      Clinically, sensory (paresthesia and hypoesthesia), motor deficits and pain occur in the
      distribution of the median nerve secondary to mechanical compression and local ischemia.

      Conservative treatment options are available for patients diagnosed with mild and moderate
      CTS as a result of CTS classification. Treatment options for symptom relief include physical
      therapy applications, splinting, and wrist injections. Among local injection treatments;
      applications such as corticosteroids and local anesthetics are included.

      Ultrasound-guided injections of peripheral nerves are generally superior to blind injections
      as they prevent damage to critical vascular structures in the surrounding tissue accompanying
      the nerves and reduce the risk of intraneural injections.

      Ultrasound (US) guided hydrodissection of peripheral nerves (HD) is a technique that uses
      high-resolution ultrasound-guided fluid injection to separate nerves from a surrounding or
      adjacent structure, usually fascia. The aim is to restore function to the nerve and to
      release soft tissue adhesions that cause entrapment.

      This investigation was designed double-blind prospective randomized study. Participants were
      randomized into 4 groups: Ultrasound-guided Hydrodissection (HD) with 5 cc 5% dextrose,
      Ultrasound-guided Hydrodissection (HD) with 5 cc normal saline, Ultrasound-guided
      Hydrodissection (HD) with 10 cc 5% dextrose, Ultrasound-guided Hydrodissection (HD) with 10
      cc normal saline.

      Ultrasonographic evaluation and ultrasound-guided injection were planned to be performed with
      the 10-18-MHz linear probe of the MyLab 70 (Esaote, Genova, Italy) device by a physician
      experienced in US. It was designed in such a way that the physician was blind to the clinical
      information of the patients and the injected material.

      As evaluation parameters, Visual Analogue Scale (VAS), Boston Carpal Tunnel Syndrome
      Questionnaire (BCTQ), Cross-sectional Area of Median Nerve (CSA), Hand and finger grip
      strength assessment, and Electrophysiological assessment will be evaluated. It was planned
      that the evaluations were made and recorded by a blinded physician to the groups at the
      beginning of the treatment, at the 1st month and at the 3rd month controls.
    

Intervention name(s): Ultrasound-guided Hydrodissection (HD) with 5 cc 5% Dextrose; Ultrasound-guided Hydrodissection (HD) with 5 cc Normal Saline; Ultrasound-guided Hydrodissection (HD) with 10 cc 5% Dextrose; Ultrasound-guided Hydrodissection (HD) with 10 cc Normal Saline
Intervention type(s): Procedure; Procedure; Procedure; Procedure
Intervention description(s): The median nerve will be defined at the proximal entrance of the carpal tunnel (scaphoid-pisiform plane). Under the ulnar approach with the in-plane technique, first it was planned to hydrodissect the median nerve from the retinaculum superiorly and then from the flexor tendons inferiorly, using 5 cc of 5% dextrose.; The median nerve will be defined at the proximal entrance of the carpal tunnel (scaphoid-pisiform plane). Under the ulnar approach with the in-plane technique, first it was planned to hydrodissect the median nerve from the retinaculum superiorly and then from the flexor tendons inferiorly, using 5 cc normal saline.; The median nerve will be defined at the proximal entrance of the carpal tunnel (scaphoid-pisiform plane). Under the ulnar approach with the in-plane technique, first it was planned to hydrodissect the median nerve from the retinaculum superiorly and then from the flexor tendons inferiorly, using 10 cc 5% dextrose.; The median nerve will be defined at the proximal entrance of the carpal tunnel (scaphoid-pisiform plane). Under the ulnar approach with the in-plane technique, first it was planned to hydrodissect the median nerve from the retinaculum superiorly and then from the flexor tendons inferiorly, using 10 cc normal saline.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Carpal Tunnel Syndrome; Ultrasound-Guided Injection; Hydrodissection