Effectiveness of Ultrasound Guided Corticoanesthetic Injection in Carpal Tunnel Syndrome

Study Overview
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Brief Summary
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Effectiveness of ultrasound guided corticoanesthetic injection in carpal tunnel syndrome treatment comparing two different injection sites. Single-blind randomized trial.

Detailed Description
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Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy. Six placebo-controlled trials with 393 participants proved corticosteroid injection to be effective in symptom relief. However, all injections were palpation-guided. Therefore, the exact injection site was uncertain. Although three studies comparing palpation and ultrasound (US) guided CTS injection showed US superiority, the optimal injection site for the injectate delivery remains unclear. Some authors believe in thinning of the flexor tenosynovium as the mechanism of the median nerve decompression, and therefore recommend injection between the tendons, away from the nerve. Other authors stress the importance of hydrodissection and direct contact of the injectate with the nerve and suggest injection targeting the median nerve. According to our best knowledge, no study comparing different injection sites for a corticosteroid delivery in CTS has been published in English written literature. The objective of this study was to determine the optimal target site for the corticosteroid delivery in CTS injection.

Official Title
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Effectiveness of Ultrasound Guided Corticoanesthetic Injection in Carpal Tunnel Syndrome Comparing Two Different Injection Sites

Conditions
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Carpal Tunnel Syndrome

Intervention / Treatment
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* Procedure: carpal tunnel corticoanesthetic injection


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: primary idiopathic CTS symptoms of classic or probable CTS (numbness or tingling in at least 2 of the 4 radial fingers) unsuccessful 1-month treatment with wrist splinting nerve conduction test results that showed median neuropathy at the wrist Exclusion Criteria: previous steroid injection diabetes mellitus, thyroid disorder inflammatory disease polyneuropathy current pregnancy previous carpal tunnel surgery severe illness inability to respond to questionnaires

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 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
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Group A<br>carpal tunnel corticoanesthetic injection between the flexor tendons | Procedure: carpal tunnel corticoanesthetic injection<br>* Different Injection Sites (between the flexot tendons or around the median nerve with hydrodissection)<br>* Other names: injetion with corticosteroid and local aneshtetics;|
| Active Comparator: Group B<br>carpal tunnel corticoanesthetic injection next to the median nerve with hydrodissection | Procedure: carpal tunnel corticoanesthetic injection<br>* Different Injection Sites (between the flexot tendons or around the median nerve with hydrodissection)<br>* Other names: injetion with corticosteroid and local aneshtetics;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual analogue scale | pain severity scale | up to 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Michigan Hand Outcomes Measure | Hand function status | up to 1 year | 
| Boston carpal tunnel questionnaire | Hand function status | up to 1 year | 
| Procedural CAS | discomfort during the internetion | up to 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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carpal tunnel injection, corticosteroid, ultrasound-guided, musculoskeletal ultrasound