Abstract
Objective
To review the literature and assess the comparative effectiveness of ultrasound-guided
versus landmark-guided local corticosteroid injections in patients with carpal tunnel
syndrome (CTS).
Data Sources
Cochrane Central Register of Controlled Trials, MEDLINE (PubMed), Embase (Ovid), and
Web of Science (from inception to February 1, 2017).
Study Selection
Randomized controlled trials (RCTs) comparing ultrasound-guided injection with landmark-guided
injection in patients with CTS were included.
Data Extraction
Two authors independently screened abstracts and full texts. The outcomes of interest
were Symptom Severity Scale (SSS) and Functional Status Scale (FSS) scores of the
Boston Carpal Tunnel Questionnaire and 4 electrodiagnostic parameters, including compound
muscle action potential (CMAP), sensory nerve action potential (SNAP), distal motor
latency (DML), and distal sensory latency (DSL).
Data Synthesis
Overall, 569 abstracts were retrieved and checked for eligibility; finally, 3 RCTs
were included (181 injected hands). Pooled analysis showed that ultrasound-guided
injection was more effective in SSS improvement (mean difference [MD], −.46; 95% confidence
interval [CI], −.59 to −.32; P<.00001), whereas no significant difference was observed between the 2 methods in
terms of the FSS (MD, −.25; 95% CI, −.56 to .05; P=.10). There were also no statistically significant differences in improvements of
CMAP (MD, 1.54; 95% CI, 0.01 to 3.07; P=.05), SNAP (MD, −0.02; 95% CI, −6.27 to 6.23; P>.99), DML (MD, .05; 95% CI, −.30 to .39; P=.80), or DSL (MD, .00; 95% CI, −.65 to .65; P>.99).
Conclusions
This review suggested that ultrasound-guided injection was more effective than landmark-guided
injection in symptom severity improvement in patients with CTS; however, no significant
differences were observed in functional status or electrodiagnostic improvements between
the 2 methods.
Keywords
List of abbreviations:
BCTQ (Boston Carpal Tunnel Syndrome Questionnaire), CI (confidence interval), CMAP (compound muscle action potential), CTS (carpal tunnel syndrome), DML (distal motor latency), DSL (distal sensory latency), FSS (Functional Status Scale), MD (mean difference), RCT (randomized controlled trial), SNAP (sensory nerve action potential), SSS (Symptom Severity Scale)To read this article in full you will need to make a payment
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References
- Current options for nonsurgical management of carpal tunnel syndrome.Int J Clin Rheumtol. 2010; 5: 129-142
- Efficacy, safety, and cost of surgical versus nonsurgical treatment for carpal tunnel syndrome: a systematic review and meta-analysis.Medicine (Baltimore). 2016; 95: e4857
- The safest location for steroid injection in the treatment of carpal tunnel syndrome.J Hand Surg Br. 2005; 30: 412-414
- Carpal tunnel injections: a novel approach based on wrist width.J Hand Microsurg. 2016; 8: 21-26
- A safe, reliable method of carpal tunnel injection.J Hand Surg Am. 1992; 17: 1160-1161
- Sonographically guided carpal tunnel injections: the ulnar approach.J Ultrasound Med. 2008; 27: 1485-1490
- Carpal tunnel injection: with or without ultrasound guidance?.PM R. 2011; 3: 976-981
- The use of ultrasound in guiding musculoskeletal interventional procedures.Phys Med Rehabil Clin N Am. 2010; 21: 559-583
- Ultrasound-guided vs. blind steroid injections in carpal tunnel syndrome: a single-blind randomized prospective study.Am J Phys Med Rehabil. 2013; 92: 999-1004
- Effectiveness of ultrasound-guided carpal tunnel injection using in-plane ulnar approach: a prospective, randomized, single-blinded study.Medicine (Baltimore). 2014; 93: e350
- A randomized prospective comparison of ultrasound-guided and landmark-guided steroid injections for carpal tunnel syndrome.J Clin Neurophysiol. 2017; 34: 107-113
- Cochrane handbook for systematic reviews of interventions version 5.1.0.The Cochrane Collaboration, 2011
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.BMJ. 2009; 339: b2700
- 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
- Ultrasound- or nerve stimulation-guided wrist blocks for carpal tunnel release: a randomized prospective comparative study.Reg Anesth Pain Med. 2008; 33: 363-368
- Outcomes and cost-effectiveness of carpal tunnel injections using sonographic needle guidance.Clin Rheumatol. 2014; 33: 849-858
- The efficacy of 100 and 300 mg gabapentin in the treatment of carpal tunnel syndrome.Iran J Pharm Res. 2015; 14: 1275-1280
- Effectiveness of Lavendula stoechas essential oil in treatment of mild to moderate carpal tunnel syndrome: a randomized controlled trial.J Hand Ther. 2017 Aug 10; ([Epub ahead of print])
- Local corticosteroid injection for carpal tunnel syndrome.Cochrane Database Syst Rev. 2007; : CD001554
- Role of diagnostic ultrasound in the assessment of musculoskeletal diseases.Ther Adv Musculoskelet Dis. 2012; 4: 341-355
- Update in musculoskeletal ultrasound research.Sports Health. 2016; 8: 429-437
- Economics of musculoskeletal ultrasound.Curr Radiol Rep. 2016; 4: 44
- Musculoskeletal ultrasound for interventional physiatry.Eur J Phys Rehabil Med. 2012; 48: 675-687
- Musculoskeletal interventional ultrasound.Semin Musculoskelet Radiol. 2007; 11: 192-198
- Intralesional therapy in carpal tunnel syndrome: a sonographic-guided approach.Clin Exp Rheumatol. 2002; 20: 73-76
- A Bayesian network meta-analysis: comparing the clinical effectiveness of local corticosteroid injections using different treatment strategies for carpal tunnel syndrome.BMC Musculoskelet Disord. 2015; 16: 363
- The effectiveness of ultrasound-guided compared to blind steroid injections in the treatment of carpal tunnel syndrome.Arthritis Care Res (Hoboken). 2017; 69: 1060-1065
Article info
Publication history
Published online: September 21, 2017
Footnotes
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
