Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Ljubljana, Ljubljana Slovenia.
Institute of Radiology, University Medical Centre Ljubljana, Ljubljana Slovenia.
Radiol Oncol. 2022 Feb 11;56(1):14-22. doi: 10.2478/raon-2022-0004.
Carpal tunnel syndrome (CTS), one of the most common entrapment neuropathies, can, in fact, be considered as a socio-economic issue that reduces work productivity, increases disability, and requires prolonged rehabilitation. The imaging modality of choice in CTS imaging is the ultrasound (US), as several morphological parameters can be used in CTS diagnosis and follow-up. In recent years, US-guided CTS injection therapy has become an established treatment option for mild to moderate CTS. The authors of this review performed a literature search that revealed several differences in US-guided carpal tunnel injection in an attempt to unify individual stages of CTS injections protocol for future guidance: patient preparation, injection approach, needle positioning, injected medications, and injectate volume. The three approaches to carpal tunnel injections described in the literature, that is, the ulnar, radial, and longitudinal, can be implemented with single or multiple deposits and different injection volumes. Medications used for injections are corticosteroids, local anaesthetics, dextrose, saline, platelet-rich plasma, and progesterone.
Although no consensus has yet been reached as to which protocol should be used, the ulnar approach with a single deposit injected in large volumes should be considered as the first choice, while dextrose should be the first-line medication option. Furthermore, as terminological differences make it difficult to draw a uniform comparison the presented steps for US-guided carpal tunnel injection might serve as a guideline for future studies.
腕管综合征（CTS）是最常见的神经卡压综合征之一，实际上可以被视为一个社会经济问题，它降低了工作效率，增加了残疾，并需要长期康复。在 CTS 成像中，首选的成像方式是超声（US），因为可以在 CTS 诊断和随访中使用几种形态参数。近年来，US 引导下 CTS 注射治疗已成为治疗轻度至中度 CTS 的一种既定选择。本文作者进行了文献检索，发现 US 引导下腕管注射在几个方面存在差异，试图为未来的指导统一 CTS 注射方案的各个阶段：患者准备、注射方法、针定位、注射药物和注射量。文献中描述的三种腕管注射方法，即尺侧、桡侧和纵侧，可以采用单次或多次注射和不同的注射量。用于注射的药物有皮质类固醇、局部麻醉剂、葡萄糖、生理盐水、富血小板血浆和孕酮。
尽管尚未就应使用哪种方案达成共识，但应考虑首选尺侧入路、单次大剂量注射，而葡萄糖应作为一线药物选择。此外，由于术语差异使得难以进行统一比较，因此本文提出的 US 引导下腕管注射步骤可以作为未来研究的指南。
