Clinical and Electrophysiological Changes after Local Steroid Injection in the Carpal Tunnel Syndrome

Jihoon Kim; Kee Ook Lee; Bora Yoon; Yong-Duk Kim; Un Suk Jung; Sang-Jun Na

doi:10.14253/kjcn.2013.15.1.7

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

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

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

Original Article

Korean J Community Nutr 2013;15(1):7-12.

Published online: 19 January 2013

DOI: https://doi.org/10.14253/kjcn.2013.15.1.7

Clinical and Electrophysiological Changes after Local Steroid Injection in the Carpal Tunnel Syndrome

Jihoon Kim¹, Kee Ook Lee¹, Bora Yoon¹, Yong-Duk Kim¹, Un Suk Jung², Sang-Jun Na¹

¹Department of Neurology, Konyang University Hospital, Daejeon, Korea

²Department of Obstetrics and Gynecology, Konyang University Hospital, Daejeon, Korea

Address for correspondence; Sang-Jun Na Department of Neurology, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon 302-718, Korea Tel: +82-42-600-8814 Fax: +82-42-545-0050 E-mail: nukedoc@hanmail.net

Received 15 January 201315 April 2013 Accepted 3 June 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Carpal tunnel syndrome, Electrophysiology, Steroid injections

REFERENCES

1.Dawson DM. Entrapment neuropathies of the upper extremities. N Engl J Med. 1993. 329:2013–2018.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

21.Marshall S., Tardif G., Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev. 2007. CD001554.

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.

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.

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.

25.Verdugo RJ., Salinas RA., Castillo JL., Cea JG. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev. 2008. CD001552.

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.

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.

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.

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.

TOOLS

Similar articles