EARLY RESPONSE OF LOCAL STEROID INJECTION VERSUS MINI INCISION TECHNIQUE IN TREATMENT OF CARPAL TUNNEL SYNDROME
Abstract
Background: Carpal tunnel syndrome (CTS) is one of the commonest peripheral neuropathies which effects mainly middle aged women. Different techniques are being tried to decrease the post-operative pain in patients operated for CTS. The objective of this study was to compare effectiveness of local injection of steroid and mini incision technique in the treatment of carpal tunnel syndrome. Methods: This randomized control trial was conducted at department of Orthopedics and department of Neurosurgery, Ayub Teaching Hospital, Abbottabad from Aug 2011 to Feb 2013. A total of 116 patients of CTS were randomly allocated to either of the two groups.58 Patient in Group A were subjected to local steroid injection and the same number of patient in Group B underwent mini incision technique. All patients of were advised to report to the OPD after one month to determine intervention effectiveness in terms of improvement in at least one grade of pain. Results: In this study mean age of the patients was 32.8±5.1 years. Female gender was in dominance with 99 (86.3%) cases. In this study we compared the effectiveness of local steroid injection and mini incision technique in the treatment of carpel tunnel syndrome. We found out that the steroid injection was effective in 69.0% cases while mini incision technique was effective in 56.9% cases. The difference being statistically insignificant with a p-value of 0.17. Conclusion: The difference in pain after 1 month of the intervention was not statistically significant.Keywords: Carpal tunnel syndrome, neuropathy, nerve compression syndromesReferences
Geere J, Chester R, Kale S, Herold CJ. Power grip, pinch grip, manual muscle testing or thenar atrophy –which should be assessed as a motor outcome after carpal tunnel decompression? A systematic review BMC Musculoskeletal Disorders. 2007;8:114
Somaiah A, Roy AJS. Carpal tunnel syndrome. Ulster Med J 2008;77(1):6–17
Stephen AB, Mark EOD, Jagannath MS, Peter C, Roy AJS. Open carpal tunnel release-still a safe and effective operation. Ulster Med J 2008;77(1):22–4.
Hamed SA, Harfoushi FZH. Carpal tunnel release via mini-open wrist crease incision: procedure and results of four years clinical experience. Pak J Med Sci 2006;22(4):367–72
Jun–II, Hidehiro H, Hiroyuki N, Toshisuke S. Carpal tunnel syndrome: electro-physiological grading and surgical results by minimum incision open carpal tunnel release. Neurol Med Chir Tokyo 2008;48:554–9
Young JK. Limited mini–open carpal tunnel release. Kor J Spine 2008;5(1):18–23.
Tian Y, Zhao H, Wang T. Prospective comparison of endoscopic and open surgical methods for carpal tunnel syndrome. Chin Med Sci J 2007;22(2):104¬–7
Hamed SA, Harfoushi FZH. Carpal tunnel release via mini-open wrist crease incision: procedure and results of four years clinical experience. Pak J Med Sci 2006;22(4):367–72
Domingo LP, Jose LA, Gema DB, Alberto SO, Isabel M. Surgical decompression versus local steroid injection in carpal tunnel syndrome. Arthritis & Rhematism. 2005;52(2):612–9
Cranford CS, Jason Y Ho, David M K, Brian J H. Carpal tunnel syndrome. J Am Acad Orthop Surg 2007;15:537–48
Tanaka S, Wild DK, Seligman PJ, Behrens V, Cameron L, Putz-Anderson V. The US prevalence of self-reported carpal tunnel syndrome: 1988 National Health Interview Survey data. Am J Public Health 1994;84(11):1846–8.
Palmer DH, Hanrahan LP. Social and economic costs of carpal tunnel surgery. Instr Course Lect 1995;44:167–72.
Burke FD. Carpal tunnel syndrome: reconciling “demand management” with clinical need. J Hand Surg [Br] 2000;25(2):121–7.
Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282(2):153–8.
de Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol. 1992;45(4):373–6.
Stevens JC, Sun S, Beard CM, O'Fallon WM, Kurland CM. Carpal tunnel syndrome in Rochester, Minnesota, 1961 to 1980. Neurology. 1988;38(1):134–8.
Einhorn N, Leddy JP. Pitfalls of endoscopic carpal tunnel release. Orthop Clin North Am. 1996;27(2):373–80.
Ferry S, Pritchard T, Keenan J, Croft CM, Silman CM. Estimating the prevalence of delayed median nerve conduction in the general population. Br J Rheumatol 1998;37(6):630–5.
Prick JJ, Blaauw G, Vredeveld JW, Oosterloo SJ. Results of carpal tunnel release. Eur J Neurol. 2003;10(6):733–6.
Phalen CM. The carpal-tunnel syndrome. Seventeen years' experience in diagnosis and treatment of six hundred fifty-four hands. J Bone Joint Surg Am 1966;48(2):211–28.
Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidence in a general population. Neurology 2002;58(2):289–94.
Practice parameter for electro diagnostic studies in carpal tunnel syndrome. American Academy of Neurology, American Association of Electro diagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation. Neurology. 1993;43(11):2404–5.
Practice parameter for carpal tunnel syndrome (summary statement). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 1993;43(11):2406–9.
Kuschner SH, Ebramzadeh E, Johnson D, Brien WW, Sherman R. Tinel's sign and Phalen's test in carpal tunnel syndrome. Orthopedics. 1992;15(11):1297–302.
Buch-Jaeger N, Foucher G. Correlation of clinical signs with nerve conduction tests in the diagnosis of carpal tunnel syndrome. J Hand Surg [Br] 1994;19(6):720–4.
Katz JN, Larson MG, Sabra A, Krarup C, Stirrat CR, Sethi R, et al. The carpal tunnel syndrome: diagnostic utility of the history and physical examination findings. Ann Intern Med. 1990;112(5):321–7.
Hui AC, Wong S, Leung CH, Tong P, Mok V, Poon D, et al. A randomized controlled trial of surgery vs. steroid injection for carpal tunnel syndrome. Neurology. 2005;64(12):2074–8.
Agarwal V, Singh R, Sachdev A, Wiclaff, Shekhar S, Goel D. A prospective study of the long-term efficacy of local methyl prednisolone acetate injection in the management of mild carpal tunnel syndrome. Rheumatology (Oxford) 2005;44(5):647–50
Ly-Pen D, Andreu JL, de Blas G, Sanchez-Olaso A, Millan I. Surgical decompression versus local steroid injection in carpal tunnel syndrome: a one-year, prospective, randomized, open, controlled clinical trial. Arthritis Rheum. 2005;52(2):612–9
Harris CM, Tanner E, Goldstein MN, Pettee DS. The surgical treatment of the carpal-tunnel syndrome correlated with preoperative nerve-conduction studies. J Bone Joint Surg Am 1979;61(1):93–8.
Keith MW, Masear V, Chung K, Amadio PC, Andary M, et al. Clinical Practice Guideline On The Treatment Of Carpal Tunnel Syndrome Adopted By The American Academy Of Orthopaedic Surgeons Board of Directors. Rosemont 2008;1:1–76.
Atik TL, Smith B, Baratz ME. Risk of neurovascular injury with limited-open carpal tunnel release: defining the “safe-zone” J Hand Surg [Br] 2001;26(5):484–7.
Jimenez DF, Gibbs SR, Clapper AT. Endoscopic treatment of carpal tunnel syndrome: a critical review. J Neurosurg 1998;88(5):817–26.
Downloads
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.