Delto-Tricipital Compression Syndrome: Treated With Injection of Dextrose

Study Overview
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Brief Summary
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The posterior antebrachial cutaneous nerve (PACN) can be compressed between the deltoid and triceps, with resultant pain and dysfunction. The active treatment for this study will be injection of the point of compression and along the painful course of the sensory nerve with 5% dextrose. The control treatment will be physical therapy.

Detailed Description
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The PACN is a purely sensory nerve that originates in the midforearm, courses anterior to the lateral epicondyle, and travels proximally until it dives between the posterior portion of the V shaped insertion of the deltoid and the external? insertion of the triceps, whereupon it joins with the radial nerve. A proposed pathological explanation is that repetitive co-contraction produces irritation and compression of the nerve at the delto-tricipital (D-T) fascial penetration point. Clinically the patient experiences pain localized to that compression point, and traveling distally along the course of some or all of the posterior femoral cutaneous nerve. Perineural injection of dextrose has been previously reported for therapeutic use in chronic pain associated with Achilles tendinopathy. Empirically,injection of D5W with a small needle along the course of the PACN and at the D-T penetrator has been found to resolve both pain and dysfunction (describe dysfunction). Participants will be randomly assigned to either 1 month of physical therapy or to 0,1,2 and 3 week injection of D5W. The use of standardized measurement tools for pain (0-10 numerical rating scale) and function (Quick DASH) will be utilized to determine baseline status and status at 1 month. At 1 month, subjects receiving therapy will be allowed to cross over to injection treatment and all participants will receive as needed treatment until the 1 year period of follow-up. Thus only 1 month data is randomized but long term data will be gathered.

Official Title
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Delto-Tricipital Compression Syndrome: A Randomized Treatment Comparison Trial of Dextrose Injection Versus Physical Therapy.

Conditions
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Superficial Radial Nerve Lesion

Intervention / Treatment
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* Drug: Dextrose 5% (D5W)
* Other: Physical therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pain in the deltotricipital groove,extending down the lateral septum. Pain rating 6 or more on a 0-10 numerical rating scale (NRS) Reproduction of pain with provocative maneuvers. Lifting a 6 pound weight to 60 degrees with the below at 40 degrees of elbow extension and the clinician creating a flexion force on the elbow which the participant resists. (Need a picture) Pain more than 3 months? Exclusion Criteria: Pain in other arm or shoulder locations on either side more than 2/10 Pain in other part of the body more than 4/10. Taking narcotics for pain. Pain with testing of shoulder laxity. Massive rupture of rotator cuff (complete width tear) evidenced by examination or MRI scan. Level III-IV or more shoulder arthritis on plain film of shoulder. Other peripheral neuropathy. Unstable psychiatric status

Ages Eligible for Study
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Minimum Age: 20 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
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Dextrose 5% (D5W) Injection<br>Glucose injection in 5% concentration, administered weekly X 4 times in a volume of 12 ml or less. | Drug: Dextrose 5% (D5W)<br>* 0,1,2, and 3 week injection sessions consisting of injection of 2 ml of D5W into the D-T groove at the point of maximal pain at 1-2 cm depth, followed by subcutaneous injection of D5W at 4 cm intervals along the course of the PACN if tenderness is present.<br>* Other names: glucose 5% in water;|
| Active Comparator: Physical Therapy<br>Physical therapy for a month in the posterior deltoid region 3 times a week. | Other: Physical therapy<br>* Three times weekly X 3 week sessions to include myofascial release, exercise, and one modality.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| NRS Pain (0-10 Numerical Rating Scale) | 0-10 Numerical Rating Scale for pain. | Time 0 and 1 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quick Dash Score | Validated shortened version of Disabilities of Arm Shoulder and Hand score. | Time 0 and 1 month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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radial neuropathy