title: Effects of steroid with repetitive procaine HCl injection in the management of carpal tunnel syndrome: an ultrasonographic study.
abstract: OBJECTIVE
  With the use of musculoskeletal ultrasonography (MSUS), morphological changes in the median nerve have been recently reported in patients with carpal tunnel syndrome (CTS). On the other hand, the literature still lacks the information whether those changes are further altered with steroid and local anesthetic injection which is a widely used treatment in this group of patients. Therefore, the aim of our study was to explore in-vivo the effects of steroid with repetitive procaine HCl injection on the median nerve of patients with CTS.
  
  
  METHODS
  This prospective clinical trial followed-up patients for 2 months. 22 patients (37 median nerves) with clinical and electrophysiological evidence of CTS were included in the study. All patients received both 40 mg of triamcinolone acetonide once and 4 ml of 1% procaine HCl twice a week for 2 weeks with the same technique. Clinical, functional, electrophysiological and ultrasonographic evaluations were performed at the study onset, and 2 months after the last injection.
  
  
  RESULTS
  Electrophysiological, ultrasonographic findings (median nerve anterior-posterior diameter, transverse diameter and cross sectional area in the proximal carpal tunnel and volar bulging,) VAS scores, Boston carpal tunnel symptom and function assessment scale improved significantly (P<0.05).
  
  
  CONCLUSIONS
  Steroid injection with repetitive procaine HCl injection effectively reduced the symptoms of CTS, improved the Boston carpal tunnel symptom and function assessment scale and also electrophysiological and ultrasonographic findings. Long term effects remain to be studied. Indisputably, the use of MSUS seems to be promising in this regard.
authors.affiliation: Neurology Service, Erzincan Military Hospital, Erzincan, Turkey. dromerkaradas@hotmail.com
authors.forename: Omer
authors.initials: O
authors.lastname: Karadaş
authors.forename: Ozlem Köroğlu
authors.initials: OK
authors.lastname: Omaç
authors.forename: Fatih
authors.initials: F
authors.lastname: Tok
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ozgül
authors.forename: Zeki
authors.initials: Z
authors.lastname: Odabaşi
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D002349:Carpal Tunnel Syndrome / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D019468:Disease Management; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011343:Procaine / Q000008:administration & dosage*; D011446:Prospective Studies; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D014463:Ultrasonography
chemical_list: D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D011343:Procaine; D014222:Triamcinolone Acetonide