Sonography-guided Steroid Injection for Carpal Tunnel Syndrome
Study Details
Study Description
Brief Summary
Purpose: To compare the outcome between sonography-guided steroid injection and direct steroid injection on carpal tunnel syndrome(CTS).
Condition or Disease | Intervention/Treatment | Phase |
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Phase 3 |
Detailed Description
Material and methods: We have enrolled 26 ideopathic carpal tunnel syndrome patients (minimal to moderate according to Padua's classification).Thirteen patients were allocated in sonography approach group( sonography-guided local wrist injection, SAG) and the 13 patients were placed in direct approach group(direct local injection without using sonography, DAG). One , 3 and 6 months later after injection, we performed the outcome measures, including Boston symptom and functional scale, QuickDASH, nerve conduction study and sonography. If the patients receive the second injections, we will follow their treatment outcome by phone regularly at 1,3 and 6 months after first injection. If the patients were referred to surgery, the failures of local injection were considered and we will stop follow up them. After performing all assessment, we will compare the outcomes between the two groups.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: Inject betamethasone by sonography Use 5/8 in medical needles inject betamethasone 7mg (1ml) in distal wrist crease by sonography- guided. Entering skin with 30 degrees from the ulnar side of palmaris longus tandon. Changing direction of injection to prevent median nerve injury if patients feel numbness or pain in hand. |
Drug: betamethasone
Inject betamethasone on the wrist for patient with carpal tunnel syndrome with sonography- guided, directly.
Other Names:
|
Active Comparator: Inject betamethasone directly Use 5/8 in medical needles inject betamethasone 7mg (1ml) in distal wrist crease directly. Entering skin with 30 degrees from the ulnar side of palmaris longus tandon. Changing direction of injection to prevent median nerve injury if patients feel numbness or pain in hand. |
Drug: betamethasone
Inject betamethasone on the wrist for patient with carpal tunnel syndrome with sonography- guided, directly.
Other Names:
|
Outcome Measures
Primary Outcome Measures
- QuickDASH [Change from Baseline data at 6 weeks]
Secondary Outcome Measures
- Chinese version of Boston symptom and function scale for carpal tunnel syndrome, SS & FS [Change from Baseline data at 6 weeks]
- Record the neurological symptoms perceived by patient after injection according to their describtion [Change from Baseline data at 6 weeks]
- Semmes-Weinstein Monofilament test(SWMT) [Change from Baseline data at 6 weeks]
- 2-Point Discrimination test on 2nd digit [Change from Baseline data at 6 weeks]
- Nerve conduction study done on the affected hand using Necolet Viking Quest [Change from Baseline data at 6 weeks]
We will record the latency, amplitude and conduction velocity retrieved from nerve conduction study of both motor neurons and sensory neuron
- Sonography examination done with patients sitting, elbow flexion and forearm supination placing on table [Change from Baseline data at 6 weeks]
The test will done twice and will record the average data of both the cross-section area and the bowing distance of transverse ligament of wrist.
Eligibility Criteria
Criteria
Inclusion Criteria:
- with >2 following symptoms :
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disrupt sleep result in nocturnal paresthesia.
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symptoms release by shaking hand.
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pain and paresthesia during grasping.
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any sensory symptom on first, 2th, 3th and partial 4th fingers.
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symptoms >1month.
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Padua's classification : minimal, mild, moderate)
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meet one of three diagnosis criteria of carpal tunnel syndrome.
Exclusion Criteria:
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any history can cause periphery nerve disease.
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affected side had fracture or paralysis.
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had accepted operation for carpal tunnel syndrome before.
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pregnant
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wrist or hand sprain, ulnar nerve disease cervical nerve root disease, multiple neuropathy or nerve anastomosis.
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Padua's classification: severe, extreme.
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ultrasonography show space occupying.
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patient taking anticoagulants.
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severe systemic disease.
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wrist's skin or wrist joint has infection.
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can't complete the 6 months' follow up.
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allergy to steroid.
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has cognition disorder.
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- Chang Gung Memorial Hospital
Investigators
- Study Chair: Pong Ya-Ping, MD, Rehabilitation
Study Documents (Full-Text)
None provided.More Information
Publications
- Armstrong T, Devor W, Borschel L, Contreras R. Intracarpal steroid injection is safe and effective for short-term management of carpal tunnel syndrome. Muscle Nerve. 2004 Jan;29(1):82-8.
- Breuer B, Sperber K, Wallenstein S, Kiprovski K, Calapa A, Snow B, Pappagallo M. Clinically significant placebo analgesic response in a pilot trial of botulinum B in patients with hand pain and carpal tunnel syndrome. Pain Med. 2006 Jan-Feb;7(1):16-24.
- Chang MH, Chiang HT, Lee SS, Ger LP, Lo YK. Oral drug of choice in carpal tunnel syndrome. Neurology. 1998 Aug;51(2):390-3.
- Dammers JW, Veering MM, Vermeulen M. Injection with methylprednisolone proximal to the carpal tunnel: randomised double blind trial. BMJ. 1999 Oct 2;319(7214):884-6.
- Gelberman RH, Aronson D, Weisman MH. Carpal-tunnel syndrome. Results of a prospective trial of steroid injection and splinting. J Bone Joint Surg Am. 1980 Oct;62(7):1181-4.
- Hui AC, Wong SM, Wong KS, Li E, Kay R, Yung P, Hung LK, Yu LM. Oral steroid in the treatment of carpal tunnel syndrome. Ann Rheum Dis. 2001 Aug;60(8):813-4.
- Huisstede BM, Hoogvliet P, Randsdorp MS, Glerum S, van Middelkoop M, Koes BW. Carpal tunnel syndrome. Part I: effectiveness of nonsurgical treatments--a systematic review. Arch Phys Med Rehabil. 2010 Jul;91(7):981-1004. doi: 10.1016/j.apmr.2010.03.022. Review.
- Irvine J, Chong SL, Amirjani N, Chan KM. Double-blind randomized controlled trial of low-level laser therapy in carpal tunnel syndrome. Muscle Nerve. 2004 Aug;30(2):182-7.
- Jarvik JG, Comstock BA, Kliot M, Turner JA, Chan L, Heagerty PJ, Hollingworth W, Kerrigan CL, Deyo RA. Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomised parallel-group trial. Lancet. 2009 Sep 26;374(9695):1074-81. doi: 10.1016/S0140-6736(09)61517-8.
- Kasten SJ, Louis DS. Carpal tunnel syndrome: a case of median nerve injection injury and a safe and effective method for injecting the carpal tunnel. J Fam Pract. 1996 Jul;43(1):79-82.
- Linskey ME, Segal R. Median nerve injury from local steroid injection in carpal tunnel syndrome. Neurosurgery. 1990 Mar;26(3):512-5.
- Mondelli M, Filippou G, Aretini A, Frediani B, Reale F. Ultrasonography before and after surgery in carpal tunnel syndrome and relationship with clinical and electrophysiological findings. A new outcome predictor? Scand J Rheumatol. 2008 May-Jun;37(3):219-24. doi: 10.1080/03009740801914850.
- Oztas O, Turan B, Bora I, Karakaya MK. Ultrasound therapy effect in carpal tunnel syndrome. Arch Phys Med Rehabil. 1998 Dec;79(12):1540-4.
- Piazzini DB, Aprile I, Ferrara PE, Bertolini C, Tonali P, Maggi L, Rabini A, Piantelli S, Padua L. A systematic review of conservative treatment of carpal tunnel syndrome. Clin Rehabil. 2007 Apr;21(4):299-314. Review.
- Premoselli S, Sioli P, Grossi A, Cerri C. Neutral wrist splinting in carpal tunnel syndrome: a 3- and 6-months clinical and neurophysiologic follow-up evaluation of night-only splint therapy. Eura Medicophys. 2006 Jun;42(2):121-6.
- Sevim S, Dogu O, Camdeviren H, Kaleagasi H, Aral M, Arslan E, Milcan A. Long-term effectiveness of steroid injections and splinting in mild and moderate carpal tunnel syndrome. Neurol Sci. 2004 Jun;25(2):48-52.
- Wang LY, Leong CP, Huang YC, Hung JW, Cheung SM, Pong YP. Best diagnostic criterion in high-resolution ultrasonography for carpal tunnel syndrome. Chang Gung Med J. 2008 Sep-Oct;31(5):469-76.
- Weintraub MI, Cole SP. A randomized controlled trial of the effects of a combination of static and dynamic magnetic fields on carpal tunnel syndrome. Pain Med. 2008 Jul-Aug;9(5):493-504.
- Wong SM, Hui AC, Tang A, Ho PC, Hung LK, Wong KS, Kay R, Li E. Local vs systemic corticosteroids in the treatment of carpal tunnel syndrome. Neurology. 2001 Jun 12;56(11):1565-7.
- NMRPG8A0051