Sonographic Evaluation of Patients With Carpal Tunnel Syndrome Following Steroid Injection

Study Overview
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Brief Summary
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The objective of this study was to assess sonographic changes of the median nerve after steroid injection for carpal tunnel syndrome.

Detailed Description
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Patients with CTS were recruited. The Boston Questionnaire (BQ) was administered and ultrasonographic and electrophysiological examinations were performed before and at two, six, and 12 weeks after steroid injection. Cross sectional area (CSA) was measured at 2 levels: at the tunnel inlet and in the mid-carpal tunnel. Flattening ratio (FR) was measured only in the mid-carpal tunnel. Correlation analyses between baseline ultrasonography, BQ, and electrophysiological measures were performed.

Official Title
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Sonographic Evaluation of Patients With Carpal Tunnel Syndrome Following Steroid Injection

Conditions
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Carpal Tunnel Syndrome

Intervention / Treatment
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* Drug: steroid injection


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: clinical diagnosis of CTS The diagnosis of CTS was confirmed by electrophysiological tests. Exclusion Criteria: neurologic disorders that could mimic CTS such as cervical radiculopathy, polyneuropathy, proximal median nerve entrapment, or thoracic outlet syndrome history of distal radius fracture pregnancy or lactation regular use of systemic NSAIDs or corticosteroids known allergy to corticosteroids and local anesthetics.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: All patients received steroid injection for carpel tunnel syndrome (CTS) and ultrasonographic evaluation before and after steroid injection
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: steroid injection<br>ultrasound-guided steroid injection using 1ml of 10 mg (10mg/ml) triamcinolone acetonide | Drug: steroid injection<br>* ultrasound-guided steroid injection using 1ml of 10 mg (10mg/ml) triamcinolone acetonide<br>* Other names: triamcinolone acetonide;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cross sectional area | The CSA of the median nerve was measured at 2 levels: at the carpal tunnel inlet (CSA-I; immediately prior to the proximal margin of the flexor retinaculum) and in the mid-carpal tunnel (CSA-M; at the level of the pisiform bone and scaphoid tubercle) | 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| flattening ratio | The flattening ratio was measured only at the mid-tunnel (FR-M). FR was calculated by dividing the horizontal diameter of the nerve by the vertical diameter. | 2, 6, 12 weeks | 
| Boston Carpal Tunnel Questionnaire (BQ) | The BQ was interviewed-administered to assess the severity of symptoms and functional status. | 2, 6, 12 weeks | 
| Median nerve distal motor latency | the CMAPs were obtained via surface electrodes placed on the abductor pollicis brevis muscle. The active recording electrode was placed on the muscle belly, and the reference electrode was placed on the tendon insertion. The median nerve was stimulated 8 cm proximal to the active recording electrode. Distal motor latencies were measured from the onset of stimulus artifact to the onset of the CMAP | 2, 6, 12 weeks | 
| sensory nerve conduction velocity | SNAPs were obtained using an antidromic method and recorded by surface electrodes placed at the proximal and distal interphalangeal joints of the index finger for the median nerve and the same joints of the little finger for the ulnar nerve. The median nerves were stimulated at the wrist at a distance of 14 cm from the wrist to the active electrode. Distal sensory latencies were measured from the onset of the stimulus artifact to the onset of the SNAP. SNCV was calculated dividing the distance of 14 cm by the distal sensory latency. | 2, 6, 12 weeks | 
| compound muscle action potential amplitude (CMAP) | the CMAPs were obtained via surface electrodes placed on the abductor pollicis brevis muscle. The active recording electrode was placed on the muscle belly, and the reference electrode was placed on the tendon insertion. The median nerve was stimulated 8 cm proximal to the active recording electrode. The amplitude of CMAP were measured from baseline to negative peak. | 2, 6, 12 weeks | 
| sensory nerve action potential amplitudes. | SNAPs were obtained using an antidromic method and recorded by surface electrodes placed at the proximal and distal interphalangeal joints of the index finger for the median nerve and the same joints of the little finger for the ulnar nerve. The median nerves were stimulated at the wrist at a distance of 14 cm from the wrist to the active electrode. The amplitude of SNAP were measured from baseline to negative peak. | 2, 6, 12 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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carpal tunnel syndrome