الفهرس 
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Abstract
Carpal tunnel syndrome (CTS) is the most common focal entrapment neuropathy. Although the precise etiology remains ambiguous, high-pressure-related intracarpal tunnel compression of the median nerve (MN), progressing ischemia, and mechanical strangulation that impairs neural conduction and damages the MN are broadly accepted as possible mechanisms. This study aims to evaluate the efficacy of US-guided MN hydrodissection in CTS and the important role of the US in the diagnosis and treatment of this syndrome. The study included 40 patients who underwent MN hydrodissection at the neurology department, Mansoura University Hospitals, Egypt in the period between April 2019 and April 2020. One 5-ml dose (2ml NS, 2ml dexamethasone, and 1ml lidocaine) was injected into the intracarpal region via the in-plane ulnar approach, to detach the MN from the transverse carpal ligament. All patients were observed for 30‑min post-injection for possible side effects before discharge. All the patients were subjected to full history taking and clinical examination including both general examination and neurological examination mainly clinical tests for CTS. Ultrasound was used in measurement CSA of the cases also NCS was done. Besides, all cases were classified according to US grades, BCTQ, and then assessed by VAS before and after the intervention. The primary outcome measures were the (BCTQ) score and VAS. Secondary outcomes were CSA of the median nerve. Assessments were performed before the injection and at 1, 3, and 6 months post-intervention. Firstly, among the recruited patients, there was female predominance with a mean age in the forties and overweight BMI. Almost half of the cases reported positive family history while the majority had bilateral CTS. The dominant hands were the most to be affected and all patients reported persistent sensory manifestations. In our results, we found a CSA of cut point of ≥ 11 with sensitivity of 95% and specificity of 100% in discriminating CTS cases from control subjects. Besides, follow-up results revealed that there a highly significant reduction in symptoms which is evident in SSS, FSS, pain analog scale, and diminished CSA of the MN at 1, 3, and 6 months post-injection compared with a baseline assessment. The CSA was reduced better in the 1st month by about 1.5mm² than the 3rd month by about 1.3mm² and 6th month by 1mm² from the baseline. Also, the efficacy of hydrodissection was long-lasting for the 3-time points. Finally, we found a statistically significant difference in favor of mild and moderate US group stages in comparison with sever US group stage as regards improvement in BCTQ, VAS, and CSA reduction. In conclusion, high-resolution US facilitates the diagnosis and interventional treatment of peripheral nerve entrapment. It also can serve as a predictive tool for the response to hydrodissection. Last but not least, the US-guided MN hydrodissection is a potentially effective and safe option in the management of CTS, especially for mild and moderate US staging groups.