Different doses of steroid injection in elderly patients with carpal tunnel syndrome: a triple-blind, randomized, controlled trial

Figures & data

Figure 1 Sonography, injection, and blinding for injector.

Note: The syringe was covered by a sterile opaque white paper (left picture); flexor retinaculum (FR), median nerve (MN), and the injectate (INJ) for dissection are shown in the middle picture; covering the needle at the time of withdrawal (right picture).
Abbreviations: FT, flexor tendon; CB, carpal bone.

Figure 2 Study flowchart.

Note: Group I received 80 mg triamcinolone (2 mL) and 1 mL of 2% lidocaine; Group II received 40 mg triamcinolone (1 mL), 1 mL of 2% lidocaine, and 1 mL normal saline; Group III received 1 mL of 2% lidocaine and 2 mL normal saline.

Table 1 Patients’ demographics

Variables	Group I (n=32)	Group II (n=32)	Group III (n=30)	p-value
Gender (male/female)	10/22	4/28	3/27	0.057
Age (years) (mean ± SD)	66.1±13.4	66±10	63.4±10.7	0.645
Affected hand (right/left)	18/14	16/16	19/11	0.57
Affected hand (dominant/nondominant)	19/13	16/16	19/11	0.549
Wrist circumstance (cm) (mean ± SD)	17.2±1.3	17±1	17±1	0.726
Wrist diameter (mm) (mean ± SD)	59.8±3.9	59.7±4.2	59.8±3.7	0.991
Hand length (cm) (mean ± SD)	17.5±1.3	17.5±1.1	17.3±0.8	0.801
Forearm length (cm) (mean ± SD)	23.1±1.5	23.3±1.3	23±1.5	0.618
Hand power (kg) (mean ± SD)	20.1±8.1	23.6±8.4	19.1±7.5	0.06

Note: Group I received 80 mg triamcinolone (2 mL) and 1 mL of 2% lidocaine; Group II received 40 mg triamcinolone (1 mL), 1 mL of 2% lidocaine, and 1 mL normal saline; Group III received 1 mL of 2% lidocaine and 2 mL normal saline.

Abbreviation: SD, standard deviation.

Table 2 Outcome measures at baseline and follow-up

Primary outcome measure	Treatment group	Baseline	2-week follow-up	3-month follow-up	6-month follow-up	Friedman test
VAS (mean ± SD)	Group I (n=32)	7.29±2.05*	4.24±2.09*	4.15±2.21*	2.43±1.93*	<0.001
	Group II (n=32)	6.22±2.74*	4.81±2.39*	3.23±2.03*	2±1.44	<0.001
	Group III (n=30)	5.8±1.88*	4.2±1.75*	3.19±2.12*	2.75±2.56	<0.001
Median DML (mean ± SD)	Group I (n=32)	5.08±1.35*	4.70±1.2*	4.55±1.12*	4.32±0.66*	0.001
	Group II (n=32)	5.15±1.23	5.00±1.23*	4.80±1.23*	4.65±0.8*	<0.001
	Group III (n=30)	4.69±1.51*	4.50±1.32*	4.45±1.19*	4.16±0.7*	0.887
Median SNAP (mean ± SD)	Group I (n=32)	4.05±1.55	3.73±1.5	3.80±1.39	4.04±0.75*	0.01
	Group II (n=32)	3.28±2.2	3.24±1.94	3.71±1.68	4.05±1.51*	0.025
	Group III (n=30)	3.90±1.15	3.80±1.18*	3.96±0.93*	3.86±0.36*	0.037
Inlet CSA (mean ± SD)	Group I (n=32)	11.73±2.53*	10.77±2.18*	10.78±2.39*	10.45±2.37*	0.002
	Group II (n=32)	12.23±2.49*	11.55±2.4*	11.26±2.19*	10.26±2.34*	<0.001
	Group III (n=30)	12.09±3.96*	11.23±2.72*	11.37±1.97*	10.76±2.05*	0.007
Boston (mean ± SD)	Group I (n=32)	55.81±15.04*	41.95±11.26*	40.43±12.14*	34.06±10.25*	0.001
	Group II (n=32)	47.70±11.70*	44.94±9.70*	43.41±10.97*	38.67±11.21*	<0.001
	Group III (n=30)	45.22±13.84*	40.45±11.08*	41.27±12.65*	36.94±13.04*	0.018

Notes:

* Test distribution is normal. Group I received 80 mg triamcinolone (2 mL) and 1 mL of 2% lidocaine; Group II received 40 mg triamcinolone (1 mL), 1 mL of 2% lidocaine, and 1 mL normal saline; Group III received 1 mL of 2% lidocaine and 2 mL normal saline. Bold variable represents a significant difference between groups after treatment.

Abbreviations: CSA, cross-sectional area; DML, distal motor latency; VAS, visual analog scale; SD, standard deviation; SNAP, sensory nerve action potential.

Table 3 Between-group analyses

Primary outcome	Repeated measurement ANOVA (between group)
VAS	0.399
Median DML	0.03
Inlet CSA	0.512
Boston	0.756

Note: Bold variable represents a significant difference between groups after treatment.

Abbreviations: ANOVA, analysis of variance; CSA, cross-sectional area; DML, distal motor latency; VAS, visual analog scale.