title: Effectiveness of ultrasound-guided carpal tunnel injection using in-plane ulnar approach: a prospective, randomized, single-blinded study.
abstract: The objective of this study is to evaluate the degree of symptom improvement and the change of electrophysiological and ultrasonographic findings after sonographically guided local steroid injection using an in-plane ulnar approach in carpal tunnel syndrome (CTS). Seventy-five cases of 44 patients diagnosed with CTS were included and evaluated at baseline and at 4 and 12 weeks after injection. All patients received injection with 40 mg of triamcinolone mixed with 1 mL of 1% lidocaine into the carpal tunnel using an in-plane Ultrasound (US)-guided ulnar approach, out-plane US-guided approach, and blind injection. For clinical evaluation, we used the Boston Carpal Tunnel Questionnaire (BCTQ) and electrophysiological tests. The ultrasonographic findings were also evaluated with regard to cross-sectional area and the flattening ratio of the median nerve. Subjective symptoms measured by BCTQ and median nerve conduction parameters showed significant improvement at 4 weeks in the in-plane ulnar approach group compared with the out-plane ulnar approach and blind injection. This improvement was still observed at 12 weeks. The flattening ratio and cross-sectional area of the median nerve showed a more significant decrease with the in-plane ulnar approach than with the out-plane ulnar approach and blind injection (P < 0.05). US-guided local steroid injection using an in-plane ulnar approach in the CTS may be more effective than out-plane or blind injection.
authors.affiliation: From the Department of Rehabilitation Medicine (JYL, KDP, JKL, OKL), Gachon University, Gil Medical Center, Incheon; and Department of Rehabilitation Medicine (YP), Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Yongbum
authors.initials: Y
authors.lastname: Park
authors.forename: Ki Deok
authors.initials: KD
authors.lastname: Park
authors.forename: Ju Kang
authors.initials: JK
authors.lastname: Lee
authors.forename: Oh Kyung
authors.initials: OK
authors.lastname: Lim
mesh_terms: D002349:Carpal Tunnel Syndrome / Q000188:drug therapy*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods; D008297:Male; D008475:Median Nerve / Q000000981:diagnostic imaging; D008875:Middle Aged; D009431:Neural Conduction; D011446:Prospective Studies; D016037:Single-Blind Method; D014221:Triamcinolone / Q000008:administration & dosage; D018084:Ultrasonography, Interventional; D014955:Wrist Joint / Q000000981:diagnostic imaging*
chemical_list: D005938:Glucocorticoids; D014221:Triamcinolone