A Comprehensive Evaluation of the Effect Duration of a Single Local Corticosteroid Injection in Combination with Regular Wrist Joint Splinting in Carpal Tunnel Syndrome

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Abstract

Introduction. Carpal tunnel syndrome (CTS) is the most frequent tunnel neuropathy. Local injection of corticosteroids (CS) and wrist splinting are used to treat CTS. The optimal frequency of local CS injections has not been determined.

The aim of this study was to carry out a comprehensive (clinical, electrophysiological, and ultrasound) evaluation of the effect duration of a single local injection of corticosteroid with lidocaine in patients with mild and moderate CTS, in combination with regular wrist splinting for 6 months.

Materials and methods. Changes in the clinical, neurophysiological, and ultrasound parameters were analyzed in 44 cases of mild and moderate CTS after a single local administration of CS and the use of regular wrist splinting. The results of Tinel’s test, Phalen’s test, and the Boston Questionnaire, median nerve conductivity based on electroneuromyography data, cross-sectional area of the nerve at the entrance to the carpal tunnel, and the degree of nerve flattening on ultrasound were assessed before treatment and within six months after injection.

Results. Within 6 months following injection, all patients noted a significant improvement in the clinical condition. The greatest clinical effect occurred in the first 2 months, after which the objective signs of improvement stabilized or gradually regressed. Clinical symptoms, nerve conduction values, and the cross-sectional area remained stably improved for 6 months, while the amplitude of motor and sensory responses remained stable for 2 months.

Conclusion. In mild and moderate CTS, local injection of CS and lidocaine plus splinting provides the maximum improvement in clinical, electrophysiological, and ultrasound parameters for the first 2 months. We hypothesize that a further improvement in objective results is possible with a repeat injection after 2 months.

About the authors

Vasiliy N. Kiselev

Nikiforov Russian Center for Emergency and Radiation Medicine, Saint-Petersburg

Author for correspondence.
Email: platonova@neurology.ru
Russian Federation

Nikolay Yu. Alexandrov

Almazov National Research Centre, Saint-Petersburg

Email: platonova@neurology.ru
Russian Federation

Tatyana M. Alexeeva

Almazov National Research Centre, Saint-Petersburg

Email: platonova@neurology.ru
Russian Federation

References

  1. Atroshi I., Gummesson C., Johnsson R. et al. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999; 282: 153–158. doi: 10.1001/jama.282.2.153. PMID: 10411196.
  2. Sunderland S. The nerve lesion in the carpal tunnel syndrome. J Neurol Neurosurg Psychiatry 1976; 39: 615–626. doi: 10.1136/jnnp.39.7.615. PMID: 993794.
  3. Ibrahim I., Khan W.S., Goddard N., Smitham P. Carpal tunnel syndrome: a review of the recent literature. Open Orthop J 2012; 6: 69–76. doi: 10.2174/1874325001206010069. PMID: 3314870.
  4. Aroori S., Spence R.A. Carpal tunnel syndrome. Ulster Med J 2008; 77: 6–17. PMID: 18269111.
  5. Chen Y.T., Williams L., Zak M.J., Fredericson M. Review of ultrasonography in the diagnosis of carpal tunnel syndrome and a proposed scanning protocol. J Ultrasound Med 2016; 35: 2311–2324. doi: 10.7863/ultra.15.12014. PMID: 27629754.
  6. Roll S.C., Evans K.D., Li X. et al. Screening for carpal tunnel syndrome using sonography. J Ultrasound Med 2011; 30: 1657–1667. doi: 10.7863/jum.2011.30.12.1657. PMID: 3654536.
  7. Stevens J.C. AAEM minimonograph #26: The electrodiagnosis of carpal tunnel syndrome. Muscle Nerve 1997; 20: 1477–1486. doi: 10.1002/(sici)1097-4598(199712)20:12<1477::aid-mus1>3.0.co;2-5 PMID: 9390659.
  8. Suponeva N.A., Piradov M.A., Gnedovskaya E.V. et al. [Carpal tunnel syndrome: diagnosis, treatment, rehabilitation (review)]. Ulyanovsk Medico-biological Journal 2016; (2): 91–97.
  9. Marshall S., Tardif G., Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev 2007; (2): CD001554. doi: 10.1002/14651858.CD001554.pub2. PMID: 17443508.
  10. Page M.J., Massy-Westropp N., O’Connor D. et al. Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev 2012; 11: CD010003. doi: 10.1002/14651858. PMID: 22786532.
  11. Huisstede B.M., Friden J, Coert J.H. et al. Carpal tunnel syndrome: hand surgeons, hand therapists, and physical medicine and rehabilitation physicians agree on a multidisciplinary treatment guideline-results from the European HANDGUIDE Study. Arch Phys Med Rehabil 2014; 95: 2253–2263. doi: 10.1016/j.apmr.2014.06.022. PMID: 25127999.
  12. Kiselev V.N., Aleksandrov N.Y., Korotkevich M.M. [Local administration of corticosteroids in treatment of carpal tunnel syndrome]. Neuromuscular Diseases 2018; 8: 10–19. doi: 10.17650/2222-8721-2018-8-1-10-19. (In Russ.)
  13. Dammers J.W., Veering M.M., Vermeulen M. Injection with methylprednisolone proximal to the carpal tunnel: randomised double blind trial. BMJ 1999; 319: 884–886. doi: 10.1136/bmj.319.7214.884. PMID: 10506042.
  14. Girlanda P., Dattola R.,Venuto C. et al. Local steroid treatment in idiopathic carpal tunnel syndrome: short and long-term efficacy. J Neurol 1993; 240: 187–190. doi: 10.1007/BF00857526. PMID: 8482993.
  15. Armstrong T., Devor W., Borschel L. et al. Intracarpal steroid injection is safe and effective for short-term management of carpal tunnel syndrome. Muscle Nerve 2004; 29: 82–88. doi: 10.1002/mus.10512. PMID: 14694502.
  16. Hagebeuk E.E., de Weerd A.W. Clinical and electrophysiological follow-up after local steroid injection in the carpal tunnel syndrome. Clin Neurophysiol 2004; 115: 1464–1468. doi: 10.1016/j.clinph.2004.01.005. PMID: 15134716.
  17. Li M., Jiang J., Zhou Q., Zhang C. Sonographic follow-up after endoscopic carpal tunnel release for severe carpal tunnel syndrome : a one-year neuroanatomical prospective observational study. BMC Musculoskelet Disord 2019; 20: 157. doi: 10.1186/s12891-019-2548-6. PMID: 30967143.
  18. Oh W., Kang H., Koh I. et al. Morphologic change of nerve and symptom relief are similar after mini- incision and endoscopic carpal tunnel release : a randomized trial. BMC Musculoskelet Disord 2017, 18: 1–8. doi: 10.1186/s12891-017-1438-z. PMID: 28158978.
  19. Smidt M.H., Visser, L. Carpal tunnel syndrome: clinical and sonographic follow-up after surgery. Muscle Nerve 2008, 38: 987–991. doi: 10.1002/mus.20982. PMID: 18537147.
  20. Asadov R., Erdal A., Buğdayci O. et al. The effectiveness of ultrasonography and ultrasonographic elastography in the diagnosis of carpal tunnel syndrome and evaluation of treatment response after steroid injection. Eur J Radiol 2018, 108: 172–176. doi: 10.1016/j.ejrad.2018.09.027. PMID: 30396651.
  21. Wang K., Huang Y., Chiu J. Sonographic median nerve change after steroid injection for carpal tunnel syndrome. Muscle Nerve 2018, 58: 402–406. doi: 10.1002/mus.26171. PMID: 29781124.
  22. Chakkalakkoombil S., Nair P. Role of ultrasound to monitor patients with carpal tunnel syndrome treated with a local corticosteroid. J Ultrasound Med 2019, 17: 1–6. doi: 10.1002/jum.14932. PMID: 30653694.
  23. Yusupova D.G., Suponeva N.A., Zimin A.A. et al. [Validation of the Boston Carpal Tunnel Questionnaire in Russia]. Neuromuscular Diseases 2018; 8(1): 38–45. doi: 10.17650/2222-8721-2018-8-1-38-45. (In Russ.)

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Copyright (c) 2020 Kiselev V.N., Alexandrov N.Y., Alexeeva T.M.

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