Yeom Ji Woong, Cho Jin-Ho, Kim Seung Joo, Lee Hyun Il
Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University, Goyang, Korea of Republic.
Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University, Goyang, Korea of Republic.
J Hand Surg Am. 2023 Jan;48(1):85.e1-85.e10. doi: 10.1016/j.jhsa.2021.09.022. Epub 2021 Nov 26.
Local steroid injection is an effective treatment modality for carpal tunnel syndrome. This study aimed to investigate the success rate of ultrasonography-guided local steroid injection and determine the prognostic value of the cross-sectional area (CSA) of the median nerve for steroid injection.
We retrospectively evaluated 40 patients with carpal tunnel syndrome whose median nerve CSA was >15 mm (large-CSA group; n = 16) or ≤15 mm (small-CSA group; n = 24). The CSA was measured using ultrasonography, and all the patients were treated with ultrasonography-guided corticosteroid injection. Demographic characteristics, symptoms, initial QuickDASH score, Boston Carpal Tunnel Questionnaires, and results of the nerve conduction study were assessed at baseline. Treatment success was defined in this study as the absence of symptom recurrence within the entire follow-up period.
The treatment success rate was 45% (n = 18) after an average follow-up of 16 months. Overall, 11 patients (28%) underwent carpal tunnel release on an average of 11 months after steroid injection. The large-CSA group showed a significantly worse grade of electrodiagnostic testing at baseline than did the small-CSA group; however, there was no significant difference in final Boston Carpal Tunnel Questionnaires symptom score (1.7 vs 1.8, respectively) and the rate of continued treatment success at the last follow-up (42% vs 50%, respectively). The proportions of patients who required carpal tunnel decompression were 29% and 25% in the small-CSA and large-CSA groups, respectively.
Local steroid injection for carpal tunnel syndrome has an overall success rate of 45% after a mean follow-up of 16 months. Preinjection CSA was not associated with whether the steroid injection was considered successful. This indicates that increased median nerve CSA does not preclude the possibility of symptomatic relief after a local steroid injection.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
局部注射类固醇是治疗腕管综合征的一种有效方法。本研究旨在探讨超声引导下局部注射类固醇的成功率，并确定正中神经横截面积（CSA）对类固醇注射的预后价值。
我们回顾性评估了40例腕管综合征患者，其正中神经CSA＞15mm（大CSA组；n = 16）或≤15mm（小CSA组；n = 24）。使用超声测量CSA，所有患者均接受超声引导下皮质类固醇注射治疗。在基线时评估人口统计学特征、症状、初始QuickDASH评分、波士顿腕管问卷以及神经传导研究结果。本研究将治疗成功定义为在整个随访期内无症状复发。
平均随访16个月后，治疗成功率为45%（n = 18）。总体而言，11例患者（28%）在类固醇注射后平均11个月接受了腕管松解术。大CSA组在基线时的电诊断测试等级明显比小CSA组差；然而，最终波士顿腕管问卷症状评分（分别为1.7和1.8）以及最后一次随访时持续治疗成功的比率（分别为42%和50%）没有显著差异。小CSA组和大CSA组中需要进行腕管减压的患者比例分别为29%和25%。
腕管综合征局部注射类固醇平均随访16个月后的总体成功率为45%。注射前的CSA与类固醇注射是否被认为成功无关。这表明正中神经CSA增加并不排除局部注射类固醇后症状缓解的可能性。
研究类型/证据水平：治疗性IV级。
