Journal List > Korean J Clin Neurophysiol > v.15(1) > 1084125

Kim, Lee, Yoon, Kim, Jung, and Na: Clinical and Electrophysiological Changes after Local Steroid Injection in the Carpal Tunnel Syndrome

Abstract

Background:

Local steroid injection is used to treat carpal tunnel syndrome (CTS). The aim of this study was to evaluate the clinical and electrophysiological effects of local steroid injection in patients with CTS over a 3-months period.

Methods:

Twenty-one patients (35 hands) with clinical and electrophysiological evidence of CTS were treated by injection of triamcinolone 40 mg to the carpal tunnel. Visual analog scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), rates of paresthesia, night awakening, and electrophysiological studies were used as outcomes. Clinical and electrophysiological assessments were performed before, 1 and 3 months after treatment.

Results:

Prior to treatment, 86% of patients complained of night awakening. At 1 and 3 months after injection, only 17% and 29% of the patients, respectively, had night awakening (p<0.001). All patients complained of paresthesia before the treatment. This symptom disappeared in 60% and 31% of the patients after 1 and 3 months, respectively (p<0.001). Compared to baseline, both BCTQ and VAS show significant improvement during the 3 months of the study (p<0.005). Although significant improvements in clinical parameters were shown, electrophysiological parameters were not significantly improved at 1 and 3 months.

Conclusions:

Local corticosteroid injection for the treatment of CTS provides significant improvement in symptoms for 3 months. On the other hand, no significant improvement was observed in electrophysiological parameters.

REFERENCES

1.Dawson DM. Entrapment neuropathies of the upper extremities. N Engl J Med. 1993. 329:2013–2018.
crossref
2.Atroshi I., Gummesson C., Johnsson R., Ornstein E., Ranstam J., Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999. 282:153–158.
crossref
3.Jablecki CK., Andary MT., Floeter MK., Miller RG., Quartly CA., Vennix MJ, et al. Practice parameter: Electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology. 2002. 58:1589–1592.
crossref
4.Boeckstyns MEH., Sørensen AI. Does endoscopic carpal tunnel release have a higher rate of complications than carpal tunnel release. An analysis of published series. J Hand Surg. 1999. 24:9–15.
5.Gerritsen AA., de Vet HC., Scholten RJ., Bertelsmann FW., de Krom MC., Bouter LM. Splinting versus surgery in the treatment of carpal tunnel syndrome. A randomized controlled trial. JAMA. 2002. 288:1245–1251.
6.Chang MH., Chiang HT., Lee SS., Ger LP., Lo YK. Oral drug of choice in carpal tunnel syndrome. Neurology. 1998. 51:390–393.
crossref
7.Chang MH., Ger LP., Hsieh PF., Huang SY. A randomised clinical trial of oral steroids in the treatment of carpal tunnel syndrome: a long term follow up. J Neurol Neurosurg Psychiatry. 2002. 73:710–714.
crossref
8.Ebenbichler GR., Resch KL., Nicolakis P., Wiesinger GF., Uhl F., Ghanem AH, et al. Ultrasound treatment for treating the carpal tunnel syndrome: randomised “sham” controlled trial. BMJ. 1998. 316:731–735.
crossref
9.Dammers JW., Veering MM., Vermeulen M. Injection with methyl prednisolone proximal to the carpal tunnel: randomized double blind trial. BMJ. 1999. 319:884–886.
10.Girlanda P., Dattola R., Venuto C., Mangiapane R., Nicolosi C., Messina C. Local steroid treatment in idiopathic carpal tunnel syndrome: short- and long-term efficacy. J Neurol. 1993. 240:187–190.
crossref
11.Gelberman RH., Aronson D., Weisman MH. Carpal tunnel syndrome: results of a prospective trial of steroid injection and splinting. J Bone Joint Surg Am. 1980. 62:1181–1184.
12.Hagebeuk EE., DeWeerd AW. Clinical and electrophysiological follow-up after local steroid injection in the carpal tunnel syndrome. Clin Neurophysiol. 2004. 115:1464–1468.
crossref
13.Agarwal V., Singh R., Sachdev A., Wiclaff ., Shekhar S., Goel D. A prospective study of the long-term efficacy of local methyl prednisolone acetate injection in the management of mild carpal tunnel syndrome. Rheumatology. 2005. 44:647–650.
crossref
14.Milo R., Kalichman L., Volchek L., Reitblat T. Local corticosteroid treatment for carpal tunnel syndrome: A 6-month clinical and electrophysiological follow-up study. J Back Muscu-loskelet Rehabil. 2009. 22:59–64.
crossref
15.Sevim S., Dogu O., Çamdeviren H., Kaleagasi H., Aral M., Arslan E, et al. Long-term effectiveness of steroid injections and splinting in mild and moderate carpal tunnel syndrome. Neurol Sci. 2004. 25:48–52.
crossref
16.O’Gradaigh D., Merry P. Corticosteroid injection for the treatment of carpal tunnel syndrome. Ann Rheum Dis. 2000. 59:918–919.
17.Giannini F., Passero S., Cioni R., Paradiso C., Battistini N., Giordano N, et al. Electrophysiologic evaluation of local steroid injection in carpal tunnel syndrome. Arch Phys Med Rehabil. 1991. 72:738–742.
crossref
18.Visser LH., Ngo Q., Groeneweg SJ., Brekelmans G. Long term effect of local corticosteroid injection for carpal tunnel syndrome: a relation with electrodiagnostic severity. Clin Neurophysiol. 2012. 123:838–841.
crossref
19.American Academy of Neurology. Practice parameter for car-pal tunnel syndrome (summary statement). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 1993. 43:2406–2409.
20.Levine DW., Simmons BP., Koris MJ., Daltroy LH., Hohl GG., Fossel AH, et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993. 75:1585–1592.
crossref
21.Marshall S., Tardif G., Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev. 2007. CD001554.
crossref
22.Hui AC., Wong S., Leung CH., Tong P., Mok V., Poon D, et al. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. Neurology. 2005. 64:2074–2078.
crossref
23.Jenkins PJ., Duckworth AD., Watts AC., McEachan JE. Corticosteroid injection for carpal tunnel syndrome: a 5-year survivorship analysis. HAND. 2012. 7:151–156.
crossref
24.Katz JN., Keller RB., Simmons BP., Rogers WD., Bessette L., Fossel AH, et al. Maine Carpal Tunnel Study: outcomes of operative and nonoperative therapy for carpal tunnel syndrome in a community-based cohort. J Hand Surg Am. 1998. 23:697–710.
crossref
25.Verdugo RJ., Salinas RA., Castillo JL., Cea JG. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev. 2008. CD001552.
crossref
26.Ly-Pen D., Andréu JL., de Blas G., Sánchez-Olaso A., Millán I. Surgical decompression versus local steroid injection in carpal tunnel syndrome: a one-year, prospective, randomized, open, controlled clinical trial. Arthritis Rheum. 2005. 52:612–619.
crossref
27.Demirci S., Kutluhan S., Koyuncuoglu HR., Kerman M., Heybeli N., Akkuş S, et al. Comparison of open carpal tunnel release and local steroid treatment outcomes in idiopathic carpal tunnel syndrome. Rheumatol Int. 2002. 22:33–37.
crossref
28.Padua L., Padua R., Aprile I., Pasqualetti P., Tonali P. Multiper-spective follow-up of untreated carpal tunnel syndrome: a mul-ticenter study. Neurology. 2001. 56:1459–1466.
crossref

Table 1.
Demographic features of the patients
Patients
Number of patients 21 (35 hands)
Age±years 48.6±11.6
Female/Male 19/2
Affected side
Right 4
Left 3
Bilateral 14
Mean duration of symptoms±SD (month) 22.4±19.3

Values are presented as mean±SD.

Table 2.
Clinical data at baseline, 1 and 3 months after treatment
Parameter Baseline 1 month 3 months
VAS 8.4±1.2 2.2±3.2* 3.6±3.5*
SSS 2.9±0.7 1.7±1.0* 2.0±1.3*
FSS 2.1±0.5 1.5±0.7* 1.7±0.8
Paresthesia (%) 100 40* 69*
Night awakening (%) 86 17* 29*

Values are presented as mean±SD.

* The results of comparison against baseline (t-test) are statistically significant at p<0.001 level,

The result of comparison against baseline (t-test) is statistically significant at p=0.002 level. VAS; visual analog scale, SSS; symptom severity scale, FSS; functional status scale.

Table 3.
Median nerve conduction study data at baseline, 1 and 3 months after treatment
Parameter Baseline 1 month 3 months
Mean±SD Mean±SD p-value Mean±SD p-value
DML, ms 5.0±1.3 4.9±1.3 0.059 4.9±1.2 0.362
CMAP, μV 8.1±2.1 8.3±1.9 0.212 8.2±1.9 0.605
SDL, ms 3.9±0.8 3.7±0.8 0.084 3.8±0.7 0.327
SNAP, μV 20.2±4.4 22.2±8.7 0.089 21.1±6.1 0.215

All p-values are in comparison against baseline values. DML; distal motor latency, CMAP; compound muscle action potential, SDL; sensory distal latency, SNAP; sensory nerve action potential.

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