Efficacy comparison between ultrasound-guided injections of 5% dextrose with corticosteroids in carpal tunnel syndrome patients

ABSTRACT

Background

There is no standard guideline for treating mild to moderate carpal tunnel syndrome (CTS). 5% dextrose perineural injection has been a potential and innovative treatment with long-term effects for CTS; however, there is few published randomized clinical trial comparing the efficacy of 5% dextrose perineural injection versus corticosteroid injection in treating CTS.

Materials and Methods

In this double-blinded randomized active-controlled trial, we randomly allocated 1 session of either 2 cc 5% dextrose or 1 cc methylprednisolone acetate mixed with 1 cc normal saline in 36 patients with mild to moderate CTS of single or both their wrists. The baseline VAS, BCTQ, electrophysiological studies, and sonography assessment of median nerve CSA were carried out at the baseline and 1-month and 3-month follow-ups, as well as recording demographic variables.

Results

A statistically significant decreasing trend in VAS (P < 0.0001), BCTQ-ss (P < 0.0001), median nerve CSA (P = 0.05), SNAP-PL (P < 0.0001), and CMAP-OL (P = 0.048) in both methylprednisolone and 5% dextrose groups was observed. No significant difference was observed in slope of the trend of studied parameters, including VAS (P = 0.95), BCTQ-ss (P = 0.88), BCTQ-F (P = 0.34), median nerve CSA (P = 0.321), SNAP-PL (P = 0.9), CMAP-OL (P = 0.799), SNAP-amplitude (P = 0.798), and CMAP-amplitude (P = 0.584).

Conclusion

5% dextrose perineural injection is an effective and safe treatment for mild to moderate CTS, in comparison with the short-term results attained from corticosteroids. Further randomized clinical trials with longer follow-up periods are warranted.

KEYWORDS:

• Median nerve
• carpal tunnel syndrome
• entrapment neuropathy
• dextrose
• injection
• steroid

Acknowledgments

This manuscript was extracted from the MD thesis (NO. 19743) of Farzaneh Rezaei Motlagh, and was approved and financially supported by the vice-chancellor of research, Shiraz University of Medical Sciences, Shiraz, Iran, with the ethics number: IR.SUMS.REC.1399.1202. The authors would like extend their gratitude towards the Research Consultation Centre (RCC) of Shiraz University of Medical Sciences, Shiraz, Iran, for statistical analysis, and Mrs. Sedigheh Shakeri, secretary at Imam-Reza PMR clinic of Shiraz University of Medical Sciences, for her management and help.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data sharing statement

The data repositories generated during the current study are not publicly available; however, would be available from the corresponding author upon reasonable request to the Vice-Chancellor of Research, Shiraz University of Medical Sciences.

Reporting Guidelines

The authors acknowledge that the manuscript is an honest, accurate, and transparent account of the study being reported and no aspects of the study have been omitted.

Additional information

Funding

The work was supported by the Shiraz University of Medical Sciences [NO. 19743]