Ultrasound-guided injection of carpal tunnel syndrome: A comparative study to blind injection

Abstract Background Carpal tunnel syndrome (CTS) is the most common upper limb neuropathy with increasing incidence especially among females, having a high economic and social impact on patients. CTS can be treated either with conservative measures or surgically. Steroid injection, as a conservative treatment, could be carried out using anatomical landmarks or via ultra-sonographic guidance. Aim of the work To compare the clinical outcomes of the ultrasound guided injection versus blinded one for management of CTS. Patients and methods Thirty patients with CTS were included in this study. Diagnosis was based on clinical, electro-physiological and ultrasound imaging. 28 patients had moderate CTS and 2 patients mild. Patients were equally grouped; 15 patients with ultrasound-guided injection technique and another 15 were injected blindly. Injection was performed once at baseline with 0.5 ml lidocaine 1% and 40 mg of triamcinolone. Evaluation at baseline and after 4 weeks of injection included Boston carpal tunnel questionnaire; symptom severity scale and functional status scale, nerve conduction study, ultrasound parameters (cross-sectional area, flattening ratio). Results Patients were 28 females and 2 males; their mean age was 35.3 ± 7.5 years with unilateral CTS and disease duration of 8.8 ± 1.9 years. Patients with ultrasound-guided injection had significant improvement of clinical, neurophysiological, ultrasound parameters outcomes than blind injected patients . Reported complications at baseline included tingling sensation in 6 (40%) patients injected blindly while non in US-guided injected. No complications were reported in all patients after 4 weeks. Conclusion Ultrasound-guided injection of the carpal tunnel provides precision, maximizes the effectiveness and reduces complications.