乌鸦传媒

CHICAGO -- Treating carpal tunnel syndrome with ultrasound (US)-guided hydrodissection with a saline injection improved function and delivered pain relief, according to a randomized trial.

Patients in the three-arm study received either US-guided hydrodissection with normal saline alone, US-guided hydrodissection with both saline and steroids, or guided perineural steroids alone.

At week 4, all three groups showed improvements in mean Boston Carpal Tunnel Questionnaire (BCTQ) scores, a patient-reported 5-point scale assessing difficulty in functioning (61.9%, 85.7%, and 100% for the three groups, respectively) along with reductions in pain, reported Anupama Tandon, MD, MBBS, of the University College of Medical Science in Delhi, India.

At 12 and 24 weeks, however, patients who received hydrodissection had continued improvements of 95-96% based on the BCTQ while the steroid-alone group had worsening BCTQ and pain scores (P<0.0001).

US-guided hydrodissection involves identifying treatable nerves with imaging, and then injecting a liquid into the nerve to separate it from the surrounding tissue.

"We used a minimally invasive technique to try to alleviate the need for carpal tunnel surgery in these patients," Tandon said. "What we propose is that with hydrodissection, the patients do well and can avoid surgery for at least 6 to 8 months."

An additional benefit of the treatment is it's "very low cost," Tandon told 乌鸦传媒. "You don't need any drugs, you don't need any specialized treatment, there is no hospitalization, and patients are ready to go back to their normal day within an hour's time."

"I think that steroids should be avoided for these procedures," Tandon added. "Steroids, of course, have their own possible adverse effects."

According to this study, "hydrodissection works better than use of steroids," Luca Sconfienza, MD, PhD, of the University of Milan, told 乌鸦传媒.

"We are not that concerned about the inflammation associated with carpal tunnel syndrome, but more about how it impinges on mobility," explained Sconfienza, who was not involved in the study. "Using ultrasound guidance, this [hydrodissection procedure] can be accomplished in 30 seconds. There is no anesthesia needed, no scars, and there is little local pain because, under ultrasound guidance, you can avoid injecting the saline into the nerve."

He added that based on the current findings, "were I to have patients who required nonsurgical carpal tunnel treatment, I would just go with the saline-[only hydrodissection], and avoid steroids."

For their study, the researchers enrolled 63 patients with a carpal tunnel syndrome diagnosis, with 21 patients assigned to each group in the 6-month long study. All were injected under US guidance to avoid injury to the nerve in the wrist.

Tandon explained that "in carpal tunnel, the nerve adheres to the surrounding structures, and when you move the wrist, you get pain and numbness in the fingers. In the group where we used saline, we could use real-time guidance to assure the nerve was separating from the other structures. Once that was accomplished, we removed the needle."

Follow-up US at 12 weeks demonstrated a "more marked" reduction of median nerve cross-sectional area in both hydrodissection groups compared with the steroid group: 43% for saline-only and 46% for saline-steroid versus 11% with steroids alone (P<0.0001). There were no significant adverse effects, Tandon reported, and patients are still being followed.

Multiple are currently evaluating US-guided hydrodissection in carpal tunnel syndrome, which affects an estimated of the U.S. population.

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