Rheumatology and Rehabilitation Department, Faculty of Medicine, Minia University, Minia, Egypt.
Internal Medicine Department, Faculty of Medicine, Minia University, Minia, Egypt.
Clin Rheumatol. 2019 Oct;38(10):2933-2940. doi: 10.1007/s10067-019-04638-7. Epub 2019 Jun 17.
To compare effectiveness of ultrasound-guided local insulin injection, local steroid injection, and local steroid followed by insulin injections in treating mild to moderate carpal tunnel syndrome (CTS) in type 2 diabetes mellitus (DM).
Study included 60 patients with electrophysiologic evidence of mild to moderate CTS. They were randomly divided into three groups: group I received insulin injection locally into the affected carpal tunnel at first visit and a similar dose after 2 weeks; group II received single injection of 40 mg methylprednisolone acetate injection; and group III received steroid injection then followed by insulin injection twice after 2 and 4 weeks. All injections were performed with ultrasonographic guidance. All patients were assessed by modified Boston Carpal Tunnel Questionnaire (FD score), CTS severity score (SS score), and neurophysiological and ultrasonographic assessments at baseline and 10 weeks after treatment.
A significant improvement in mean FD score, SS score, DML (distal motor latency), SNCV (sensory nerve conduction velocity), PSL (peak sensory latency), Samp (sensory amplitude), and CSA (cross-sectional area of median nerve) observed in all groups (with exception of mean DML and Samp in the second group and mean Samp in the third group). Group III showed significant improvement in CSA especially when compared to group II by post hoc analysis (P = 0.005).
Local insulin injection is as effective as steroid in treating mild to moderate CTS in type 2 DM and is a safer alternative. Adding insulin injections after steroid shows more sonographic improvement than steroid alone. Key Points • Local insulin injection is as effective as steroid in treating mild to moderate CTS in type 2 diabetic patients. • Measuring CSA of median nerve at CT inlet by US is a better tool for monitoring median nerve changes after treatment. • Adding insulin injections after steroid has more sonographic improvement than steroid alone.
比较超声引导下局部胰岛素注射、局部皮质类固醇注射和局部皮质类固醇注射后再行胰岛素注射治疗 2 型糖尿病（DM）患者轻中度腕管综合征（CTS）的疗效。
该研究纳入了 60 例有轻中度 CTS 电生理证据的患者。他们被随机分为三组：组 I 在首次就诊时向受累的腕管内局部注射胰岛素，2 周后给予相同剂量；组 II 单次注射 40mg 醋酸甲泼尼龙；组 III 先注射皮质类固醇，然后在 2 周和 4 周后再注射两次胰岛素。所有注射均在超声引导下进行。所有患者在基线和治疗 10 周时均采用改良波士顿腕管问卷（FD 评分）、CTS 严重程度评分（SS 评分）、神经生理和超声评估进行评估。
所有组的平均 FD 评分、SS 评分、DML（运动潜伏期）、SNCV（感觉神经传导速度）、PSL（感觉峰值潜伏期）、Samp（感觉幅度）和 CSA（正中神经横截面积）均有显著改善（除第 2 组的平均 DML 和 Samp 和第 3 组的平均 Samp 外）。事后分析显示，组 III 的 CSA 改善尤其显著，与组 II 相比差异有统计学意义（P = 0.005）。
局部胰岛素注射与皮质类固醇治疗 2 型 DM 轻中度 CTS 同样有效，且更为安全。皮质类固醇注射后加用胰岛素注射比单纯使用皮质类固醇效果更好。
局部胰岛素注射与皮质类固醇治疗 2 型糖尿病患者轻中度 CTS 同样有效。
通过超声测量 CT 入口处正中神经 CSA 是监测治疗后正中神经变化的更好工具。
皮质类固醇注射后加用胰岛素注射比单纯使用皮质类固醇效果更好。
