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Comparison of Corticosteroid Injection Dosages in Mild to Moderate Idiopathic Carpal Tunnel Syndrome: A Randomized Controlled Trial

      Abstract

      Objectives

      To evaluate whether the therapeutic effect of ultrasound-guided injections with 10 mg or 40 mg triamcinolone acetonide (TA) was dose-dependent in patients with idiopathic mild to moderate carpal tunnel syndrome (CTS).

      Design

      Prospective, double-blind, randomized controlled study with 12 weeks of follow-up.

      Setting

      Rehabilitation outpatient clinic of a single medical center.

      Participants

      Patients with CTS (N=56).

      Intervention

      Participants were randomly assigned to 2 treatment groups for injection: (A) 40 mg TA+2% lidocaine hydrochloride or (B) 10 mg TA+2% lidocaine hydrochloride.

      Main Outcome Measures

      Participants were evaluated using visual analog scale (VAS) and Boston Carpal Tunnel Questionnaire (BCTQ, including Symptom Severity Scale [SSS] and Functional Status Scale [FSS]) at baseline and 6 and 12 weeks after injection). Nerve conduction studies, including parameters of distal motor latency, amplitude of compound motor action potential, amplitude of sensory nerve action potential and sensory nerve conduction velocity of median nerve, and the patient’s subjective impression of improvement, were recorded before injection and 6 and 12 weeks after injection.

      Results

      No significant differences were observed in baseline demographic characteristics and clinical evaluations. The parameters in group A and B at baseline, 6 weeks, and 12 weeks were (1) SSS: 2.17±0.14, 1.19±0.04, and 1.34±0.09 and 1.87±0.11, 1.21±0.07, and 1.26±0.04; (2) FSS: 1.63±0.07, 1.27±0.06, and 1.33±0.08 and 1.50±0.10, 1.18±0.05, and 1.26±0.05; (3) VAS: 6.4±0.3, 2.2±0.3, and 3.0±0.1 and 6.7±0.3, 2.0±0.3, and 3.1±0.3, respectively, and significantly decreased after 6 and 12 weeks in both treatment groups (P<.05). All parameters of nerve conduction studies improved in both groups after 12 weeks (P<.05). VAS, BCTQ, and nerve conduction studies did not show significant intergroup differences after 6 and 12 weeks.

      Conclusion

      In patients with idiopathic mild to moderate CTS, ultrasound-guided injection with 10 and 40 mg TA yield similar improvements in BCTQ, VAS, and nerve conduction studies at the 12-week follow-up.

      Keywords

      List of abbreviations:

      ANOVA (analysis of variance), BCTQ (Boston Carpal Tunnel Questionnaire), CMAP (compound muscle action potential), CTS (carpal tunnel syndrome), DML (distal motor latency), FSS (Functional Status Scale), MCID (minimum clinically important difference), SNAP (sensory nerve action potential), SNCV (sensory nerve conduction velocity), SSS (Symptom Severity Scale), TA (triamcinolone acetonide), VAS (visual analog scale)
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