Advertisement

Ultrasound-Guided Versus Landmark-Guided Local Corticosteroid Injection for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Published:September 21, 2017DOI:https://doi.org/10.1016/j.apmr.2017.08.484

      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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Carlson H.
        • Colbert A.
        • Frydl J.
        • Arnall E.
        • Elliot M.
        • Carlson N.
        Current options for nonsurgical management of carpal tunnel syndrome.
        Int J Clin Rheumtol. 2010; 5: 129-142
        • Ren Y.M.
        • Wang X.S.
        • Wei Z.J.
        • et al.
        Efficacy, safety, and cost of surgical versus nonsurgical treatment for carpal tunnel syndrome: a systematic review and meta-analysis.
        Medicine (Baltimore). 2016; 95: e4857
        • Racasan O.
        • Dubert T.
        The safest location for steroid injection in the treatment of carpal tunnel syndrome.
        J Hand Surg Br. 2005; 30: 412-414
        • Menge T.J.
        • Rinker E.B.
        • Fan K.H.
        • Block J.J.
        • Lee D.H.
        Carpal tunnel injections: a novel approach based on wrist width.
        J Hand Microsurg. 2016; 8: 21-26
        • Kay N.R.
        • Marshall P.D.
        A safe, reliable method of carpal tunnel injection.
        J Hand Surg Am. 1992; 17: 1160-1161
        • Smith J.
        • Wisniewski S.J.
        • Finnoff J.T.
        • Payne J.M.
        Sonographically guided carpal tunnel injections: the ulnar approach.
        J Ultrasound Med. 2008; 27: 1485-1490
        • Goldberg G.
        • Wollstein R.
        • Chimes G.P.
        Carpal tunnel injection: with or without ultrasound guidance?.
        PM R. 2011; 3: 976-981
        • Lento P.H.
        • Strakowski J.A.
        The use of ultrasound in guiding musculoskeletal interventional procedures.
        Phys Med Rehabil Clin N Am. 2010; 21: 559-583
        • Ustün N.
        • Tok F.
        • Yagz A.E.
        • et al.
        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
        • Lee J.Y.
        • Park Y.
        • Park K.D.
        • Lee J.K.
        • Lim O.K.
        Effectiveness of ultrasound-guided carpal tunnel injection using in-plane ulnar approach: a prospective, randomized, single-blinded study.
        Medicine (Baltimore). 2014; 93: e350
        • Eslamian F.
        • Eftekharsadat B.
        • Babaei-Ghazani A.
        • Jahanjoo F.
        • Zeinali M.
        A randomized prospective comparison of ultrasound-guided and landmark-guided steroid injections for carpal tunnel syndrome.
        J Clin Neurophysiol. 2017; 34: 107-113
        • Higgins J.
        • Green S.
        Cochrane handbook for systematic reviews of interventions version 5.1.0.
        The Cochrane Collaboration, 2011
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.
        BMJ. 2009; 339: b2700
        • Levine D.W.
        • Simmons B.P.
        • Koris M.J.
        • et al.
        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
        • Macaire P.
        • Singelyn F.
        • Narchi P.
        • Paqueron X.
        Ultrasound- or nerve stimulation-guided wrist blocks for carpal tunnel release: a randomized prospective comparative study.
        Reg Anesth Pain Med. 2008; 33: 363-368
        • Makhlouf T.
        • Emil N.S.
        • Sibbitt Jr., W.L.
        • Fields R.A.
        • Bankhurst A.D.
        Outcomes and cost-effectiveness of carpal tunnel injections using sonographic needle guidance.
        Clin Rheumatol. 2014; 33: 849-858
        • Eftekharsadat B.
        • Babaei-Ghazani A.
        • Habibzadeh A.
        The efficacy of 100 and 300 mg gabapentin in the treatment of carpal tunnel syndrome.
        Iran J Pharm Res. 2015; 14: 1275-1280
        • Eftekharsadat B.
        • Roomizadeh P.
        • Torabi S.
        • Heshmati-Afshar F.
        • Jahanjoo F.
        • Babaei-Ghazani A.
        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])
        • Marshall S.
        • Tardif G.
        • Ashworth N.
        Local corticosteroid injection for carpal tunnel syndrome.
        Cochrane Database Syst Rev. 2007; : CD001554
        • Patil P.
        • Dasgupta B.
        Role of diagnostic ultrasound in the assessment of musculoskeletal diseases.
        Ther Adv Musculoskelet Dis. 2012; 4: 341-355
        • Nwawka O.K.
        Update in musculoskeletal ultrasound research.
        Sports Health. 2016; 8: 429-437
        • Bureau N.J.
        • Ziegler D.
        Economics of musculoskeletal ultrasound.
        Curr Radiol Rep. 2016; 4: 44
        • De Muynck M.
        • Parlevliet T.
        • De Cock K.
        • Vanden Bossche L.
        • Vanderstraeten G.
        • Ozcakar L.
        Musculoskeletal ultrasound for interventional physiatry.
        Eur J Phys Rehabil Med. 2012; 48: 675-687
        • Joines M.M.
        • Motamedi K.
        • Seeger L.L.
        • DiFiori J.P.
        Musculoskeletal interventional ultrasound.
        Semin Musculoskelet Radiol. 2007; 11: 192-198
        • Grassi W.
        • Farina A.
        • Filippucci E.
        • Cervini C.
        Intralesional therapy in carpal tunnel syndrome: a sonographic-guided approach.
        Clin Exp Rheumatol. 2002; 20: 73-76
        • Chen P.C.
        • Chuang C.H.
        • Tu Y.K.
        • Bai C.H.
        • Chen C.F.
        • Liaw M.
        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
        • Evers S.
        • Bryan A.J.
        • Sanders T.L.
        • Selles R.W.
        • Gelfman R.
        • Amadio P.C.
        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