الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 54 |  |  |
| | | from | 54 | | |
Abstract
Carpal tunnel syndrome is a chronic disabling disease, due to focal compression of the median nerve. It has a substantial impact on health, occupation and socioeconomic state.
Few therapeutic options can be offered, including conservative treatment (lifestyle modification, wrist splinting and NSAIDs), local steroid injection in mild to moderate cases. Surgical decompression is usually reserved for severe cases.
Two known approaches of local steroid injection are commonly applied; the blind/non-guided approach and the ultrasound-guided approach.
This study aimed to investigate the efficacy of blind and ultrasound-guided local steroid injection and to compare the outcomes of both techniques. Thirty patients with electro-physiologically proven mild or moderate carpal tunnel syndrome were enrolled, who were randomized into two equal groups.
Blind approach is conducted using a well-known anatomical target point in the wrist, which is usually just medial to the palmaris longus tendon. This approach carries a potential risk of median nerve or soft tissue injury.
Steroid injection under sonographic guidance has the benefit of adequate recognition of the anatomical structures of the carpal tunnel, proper needle placement during the procedure and confirmation of successful injection in the target point.
All procedures were performed with a 21 G needle introduced at the designated target points at both groups, followed by injection of a mixture of 1 cc of Lidocaine 1% (10mg/mL) and 1 cc of Triamcinolone Acetonide (40mg/mL).
Clinical severity assessment and sonographic examinations were performed before injection (as a baseline) and at 4 weeks afterwards. Mean scores and mean reductions were calculated and compared.
Evaluation of severity was carried out by the Boston Carpal Tunnel Questionnaire (BCTQ), formed by the Symptom Severity Scale (SSS) with the Functional Status Scale (FSS). Assessment of sonographic parameters of the median nerve was performed, including the Cross-Sectional Area (CSA) as well as the Flattening Ratio (FR).
Clinical and sonographic improvement was achieved in all patients, defined as significant decrease in mean scores of SSS, FSS, CSA and FR, 4 weeks after injection (compared to the pre-injection state).
When the two groups were compared to each other, the ultrasound-guided group exhibited statistically significant mean reductions of FSS, SSS, CSA and FR, 4 weeks after injection (compared to the pre-injection state).