Main Article Content
Background: Carpal tunnel syndrome is the most common type of peripheral nerve entrapment; it affects females more than males; it may be idiopathic or secondary to other disorders especially diabetes mellitus. Carpal tunnel syndrome mostly affects manual workers and may be bilateral or unilateral and mainly affects the dominant hand. Carpal tunnel syndrome has characteristic symptoms and signs including paresthesia and pain along median nerve distribution, these symptoms are usually accompanied by positive provocative tests. Electrodiagnostic studies remain the cornerstone in the diagnosis of CTS. Carpal tunnel syndrome can be treated conservatively by activities of daily living instructions, splints, medical treatments as neurotropic drugs and NSAIDs and local steroid injection. Also, it can be treated by surgical decompression in severe cases.
Aims: The aim of this study was to evaluate local steroid injection in the treatment of CTS. Twenty-one patients with mild and moderate CTS were included in this study.
Patients and Methods: This was a prospective study included 21 patients with symptoms and signs of mild to moderate CTS attending the outpatient clinic of orthopedic Department, Tanta University Hospitals in the period between February 2019- January 2020. 1 ml Triamcinolone was used with 2 ml lidocaine. Patient’ hand was rested on towel roll flexed about 30 to 45 degrees and injection was done according to landmarks. Night splint was described for 3 days after injection.
Results: In regards to clinical assessment; there was a significant clinical improvement after injection and follow-up period as compared to before injection. In regards to electrophysiological assessment; there was a significant improvement in NCS after injection.
Conclusion: Local steroid injection is an effective treatment and recommended as a therapeutic tool in the management of idiopathic mild to moderate CTS.
Atroshi I, Gummesson C, Johnsson R et al. Symptoms, disability, and quality of life in patients with carpal tunnel syndrome. J Hand Surg [Am]. 1999;24: 398–404.
Wintman BI, Winters SC, Gelberman RH et al. Carpal tunnel release: Correlations with preoperative symptomatology. Clin Orthop. 1996;326:135–145.
Ahlberg J, Johansson H, Widenfalk B. Disabling injuries following carpal tunnel syndrome surgery. Lakartidningen. 2007; 104:2884–2886.
Benson LS, Bare AA, Nagle DJ et al. Complications of endoscopic and open carpal tunnel release. Arthroscopy. 2006;22:919–924.
Atroshi I, Larsson GU, Ornstein E et al. Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trial. BMJ. 2006;332:1473–1476.
O'Connor D, Marshall S, Massy-Westropp N. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev. 2003;CD003219.
American Society for Surgery of the Hand: Carpal tunnel syndrome.
Ibrahim I, Khan W, Goddard N, Smitham P et al. Carpal tunnel syndrome: a review of the recent literature. Open Orthop J. 2012;6(6):69-79.
Keith MW, Masear V, Chung K, Maupin K et al. Diagnosis of carpal tunnel syndrome. J Am Acad Orthop Surg. 2009;17:389–396.
Wang L. Electrodiagnosis of carpal tunnel syndrome. Phys Med Rehabil Clin N Am. 2013;24:67–77
Klauser AS, Halpern EJ, De Zordo T et al. Carpal tunnel syndrome assessment with US: Value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology. 2009;250(1):171–177.
Shi Q, Mac J. Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? A systematic review. J Orthop Surg Res. 2011;6(2): 6-17.
Saphin G, Wollny J, Hartmann B, et al. Metaanalysis for the evaluation of risk factors for carpal tunnel syndrome occupational risk factors. Zeitschrift Ortho J. 2012;150(5):516.
Iranmanesh F, Ebrahimi HA and Shahsavari A. Sleep position in patients with carpal tunnel syndrome. Zahedan J Res Med Sci. 2015;15:29-32.
Hasan ZN and Ali SH. Provocative test's versus electrophysiological studies as a measure of severity grades of carpal tunnel syndrome. Iraqi J Med Sci; 2013;11(3):275-279.
Mohammadi A, Ghasemi-Rad M, Mladkova-Suchy N, et al. Correlation between the severity of carpal tunnel syndrome and color Doppler sonography findings. AJR. 2012;198:181–184.
Baiee RH, AL-Mukhtar NJ Al-Rubiae SJ, et al. Neurophysiological findings in patients with carpal tunnel syndrome by nerve conduction study in comparing with ultrasound study. J of Natural Sciences Research. 2015; 5:111-128.
Mohamed RE, Amin MA, Aboelsafa AA, et al. Contribution of power doppler and gray scale ultrasound of the median nerve in evaluation of carpal tunnel syndrome. The Egyptian Journal of Radiology and Nuclear Medicine. 2014;45:191–201.
Rao BH, Kutub M, Patil SD. Carpal tunnel syndrome: Assessment of correlation between clinical, neurophysiological and ultrasound characteristics. Journal of the Scientific Society. 2012;39 (3):124-129.
Atroshi I, Gummesson C, Johnsson R, et al. Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome. BMC Musculoskelet Disord. 2003;4:4-9.