Comparison of Ultrasound-Guided versus Anatomical Landmark-Guided Approach for Perineural Steroid Infiltration in Carpal Tunnel Syndrome: A Prospective Randomised Controlled Trial

Abstract

Background: Carpal tunnel syndrome (CTS), a compressive neuropathy is usually managed by conservative treatment and/or decompressive surgery. Minimally invasive perineural steroid injections have been shown to be very effective in early-onset CTS. We evaluated the clinical efficacy and safety of ultrasound (USG)-guided steroid injection over anatomical landmark-guided approach in CTS. Methodology and Results: Eighty-four consecutive Stage I-II primary CTS patients enrolled between August 2017 and December 2018 were randomised prospectively into two groups in 1:1 fashion. In Group I, anatomical landmark guided and in Group II, USG guided 1 ml steroid (40 mg methylprednisolone) was injected perineurally. Symptom and functional assessments were done using Boston Carpal Tunnel Questionnaire (BCTQ) and Visual Analogue Scale (VAS) score at 3, 6 and 12 weeks’ follow-up. Significant improvement was seen in BCTQ and VAS scores of both groups at 3 weeks follow-up. At subsequent follow-ups (at 6 and 12 weeks), marked improvement of BCTQ and VAS scores in USG-guided group was observed. Conclusion: USG-guided perineural steroid injections had early-onset significant and sustained symptom reduction and functional improvement at 6- and 12-weeks follow-up when compared to anatomical landmark-guided approach with both the techniques being equally safe.

Keywords

• blind approach
• boston carpal tunnel questionnaire
• carpal tunnel syndrome
• perineural steroid injection
• ultrasound-guided approach
• visual analogue scale