Artikel
Can cross sectional area of median nerve predict the prognosis of local steroid injection for carpal tunnel syndrome?
Suche in Medline nach
Autoren
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Hyun Il Lee
- Ilsan Paik Hospital, Goyang, South Korea
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: The local steroid injection for carpal tunnel syndrome (CTS) is effect treatment modality which usually gives immediate symptomatic relief without invasive procedure. However, the long-term efficacy is frequent concern of injection therapy and it is not well known for prognostic factor to influence the result of local steroid injection. Our purpose of this study was 1) to report the long term success rate of sonography-guided local steroid injection and 2) to determine whether cross sectional area (CSA) of median nerve could be used for prognostic factor of steroid injection.
Methods: In a retrospective study, 37 patients with CTS were treated with corticosteroid injection guided by ultrasonography. CAS of median nerve was measured at lunate level when the median nerve had the largest size of CSA. Sixteen patients were classified as severe group according to CAS larger than 15mm2. The other 21 patients were classified as mild group. Demographic factor, symptom, initial quick-DASH score, Boston carpal tunnel Questionnaires (BCTQ) and the result of nerve conduction study (NCV) was assessed at baseline. The injection failure was determined when the patients had symptomatic failure with or without re-injection and surgical release.
Results and Conclusions: Symptomatic failure rate was 51% (19 patients) in all patients. Eleven patients (30%) underwent carpal tunnel release after minimum 6 month follow-up (average 15 month).
The two group had similar baseline demographic factors. Thenar atrophy was more pronounced in severe CSA group (P=0.041). There were no significant differences in initial quick-DASH or BCTQ score, whereas amplitude of motor nerve conduction study and grade of NCV for severe CSA group was significantly severer than that of the mild CSA group. At last follow-up 50% of patients in the severe CSA group and 52% in the mild CSA group has symptomatic failure (P=0.886). Twenty five percent of patients in the severe CSA group required carpal tunnel decompression compared to 33% in mild CSA group (P=0.583)
In conclusion, Overall failure rate of steroid injection was 51%. The CSA dose not have prognostic value in prediction of the success of local steroid injection. In other words, the large CSA dose not preclude the possibility of long-term symptomatic relief after local steroid injection.
