Short Term Efficacy of 5% Dextrose Injection With Ultrasound Guided Nerve Hydrodissection Method in CTS
Condition: Carpal Tunnel Syndrome
MeSH terms: Carpal Tunnel Syndrome; Syndrome
Study type: Interventional

Summary: 
      Hydrodissection injection method; It is a safe and effective injection method in peripheral
      nerve compression that aims to release the adhesions by separating the nerve from the
      surrounding connective tissues through the liquid given by injection. Perineural injection of
      5% dextrose is analgesic in neuropathic pain, although the mechanism is not fully defined.
      USG-guided 5% dextrose injection using nerve hydrodissection method is promising in the
      treatment of CTS. In our study, we aimed to investigate the short-term (4 weeks) efficacy of
      5% dextrose injection using USG-guided nerve hydrodissection method in combination with wrist
      splint treatment in patients with mild to moderate carpal tunnel syndrome (CTS) and whether
      this treatment can provide additional benefit to wrist splint treatment.
    

Detailed description: 
      In our prospective randomized controlled study, 44 patients who met the inclusion criteria
      and had mild to moderate carpal measured syndrome with EMG as described in previous studies
      were included in the study. The 44 volunteer participants with mild to moderate carpal tunnel
      syndrome were randomly divided into 2 groups as wrist splint treatment group (control group)
      and wrist splint + 5% dextrose injection treatment group (study group) by stratified and
      block randomization method. Stratified randomization was done according to the variable of
      having mild and moderate carpal tunnel syndrome. Assignment to the treatment or control group
      for each stratum was done by 1:1 block randomization.

      All patients were given the same type of wrist splint to be used for at least 8 hours at
      night for 4 weeks, to be worn in a neutral position and in accordance with the wrist as
      described in previous studies to restrict movement in the wrist, and activities that
      aggravate symptoms (repetitive and demanding wrist movements: Knitting, keyboard use, use of
      vibrating tools, etc.) were recommended to be avoided. The given wrist splint is a
      commercially available wrist splint with a metal bar on the palmar side and Velcro straps on
      the dorsal side that can be adjusted according to the wrist, restricting flexion and
      extension of the wrist and allowing movement of the metacarpophalangeal joint. Patients who
      did not sleep for 8 hours were asked to complete 8 hours of wrist splint use before going to
      sleep or after waking up. All patients were given a wrist splint diary and asked to write
      down the days and hours of splinting. Patients who did not wear splints for enough days and
      hours were excluded from the study. In the study group, 2 ml each of 5% dextrose injection
      was administered once at the proximal wrist level above the median nerve separating the
      median nerve from the flexor retinaculum and below the median nerve separating the median
      nerve from the flexor tendons by nerve hydrodissection method in the transverse inplane plane
      under ultrasound guidance. After the application, the spread of the injectate was observed by
      looking longitudinally at the median nerve. A 25 gauge syringe was used for administration.
      Patients were observed for side effects and side effects were noted. Patients were asked to
      rate their injection pain on a Visual Analog Scale (VAS) after injection to measure the pain
      during injection. All patients were advised not to take any additional treatment for their
      symptoms during the study. Patients who received additional treatment were noted. All
      patients were evaluated with Visual Analog Scale (VAS) score, Turkish version of Boston
      Carpal Tunnel Questionnaire (BCTQ), grip strength (GS) measured by hand dynamometer, and
      median nerve cross-sectional area (CSA) measured by ultrasonography before the start of the
      study (week 0) and at the end of the 4th week.
    

Intervention name(s): wrist splint; 5% dextrose injection using USG-guided nerve hydrodissection method
Intervention type(s): Device; Procedure
Intervention description(s): The same type of wrist splint to be used for at least 8 hours at night for 4 weeks, to be worn in a neutral position and in accordance with the wrist as described in previous studies to restrict movement in the wrist. Patients who did not sleep for 8 hours were asked to complete 8 hours of wrist splint use before going to sleep or after waking up.; 2 ml each of 5% dextrose injection was administered once at the proximal wrist level above the median nerve separating the median nerve from the flexor retinaculum and below the median nerve separating the median nerve from the flexor tendons by nerve hydrodissection method in the transverse inplane plane under ultrasound guidance. After the application, the spread of the injectate was observed by looking longitudinally at the median nerve.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Prospective, randomized, clinical trials
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: carpal tunnel syndrome; hydrodissection; 5% dextrose; wrist splint