Evaluating the Effectiveness of Surgical Treatment and Local Steroid Injection in Patients with Carpal Tunnel Syndrome

Authors

1 Zabol University of Medical Sciences, Zabol, Iran

2 Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran

3 Department of Neurology, Zabol University of Medical Sciences, Zabol, Iran

4 Razavi Cancer Research Center, Razavi Hospital, Imam Reza International University, Mashhad, Iran

5 Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran. Tel: +985136004359; Email: Masoud_dr2003@yahoo.com

Abstract

Background: Carpal tunnel syndrome (CTS) is considered as the most common entrapment neuropathy. Median nerve release by surgery is a manual therapy intervention used for treating CTS. Objectives: The aim of the present study was to compare the effectiveness of surgical decompression with respect to local steroid injection in the treatment of idiopathic. Methods: In this study, 100 patients with mild and moderate carpal tunnel syndrome were assigned to two equal groups. In one group, patients received a single local injection of triamcinolone acetonide and in the other one, open carpal tunnel release was used. A number of variables including pain (based on Visual Analogue Scale), symptom severity and functional status (based on Bostone/ Levine symptom severity and functional status scale) were assessed at the baseline and after a 6-month follow-up. Analysis was carried by intention to treat. Results : the severity of symptoms in the surgery and injection groups was 2.51 and 2.61 respectively. However, in the follow-up, the severity of symptoms in the surgery group (1.77) was significantly lower than the injection group (2.62) (p

Keywords

References

1.Calandruccio JH. Carpal tunnel syndrome. In: Canale ST, Beaty JH, editors. Campbell's operative orthopaedics: adult spine surgery e-book. 12th ed. Philadelphia: Elsevier Health Sciences;
2013. P. 3637.
2. Pauda L, Pauda R, Nuzzuro M, Tonail P. Incidence of bilateral symptoms in carpal tunnel syndrome. J Hand Surg Br. 1998;23(5):603-6. [PubMed: 9821602].
3. Rhdevik B, Lundborg G, Bagge U. Effects of graded compression on intraneural blood flow. An in vivo study on
rabbit tibial nerve. J Hand Surg Am. 1981;6(1):3-12. [PubMed:7204915].
4. Chammas M, Boretto J, Burmann LM, Ramos RM, Dos Santos  Abedi M et al. Razavi Int J Med. 2018; 6(3):e14338. 5
Neto FC, et al. Carpal tunnel syndrome – Part I (anatomy, physiology, etiology and diagnosis). Rev Bras Ortop.
2014;49(5):429-36. doi: 10.1016/j.rboe.2014.08.001. [PubMed:26229841].
5. Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, et al. Carpal tunnel syndrome: clinical features, diagnosis, and
management. Lancet Neurol. 2016;15(12):1273-84. doi:10.1016/S1474-4422(16)30231-9. [PubMed: 27751557].
6. Levine D, Simmons B, Koris M, Daltroy LH, Hohl GG, Fossel AH, et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993;75(11):1585-92. [PubMed: 8245050].
7. Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain.
1997;72(1-2):95-7. [PubMed: 9272792].
8. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I. Prevalence of carpal tunnel syndrome in a general
population. JAMA. 1999;282(2):153-8. [PubMed: 10411196].
9. McDiarmid M, Oliver M, Ruser J, Gucer P. Male and female rate differences in carpal tunnel syndrome injuries: personal
attributes or job tasks? Environ Res. 2000;83(1):23-32. doi: 10.1006/enrs.2000.4042. [PubMed: 10845778].
10. Shabir M. Surgical treatment of carpal tunnel syndrome. J Postgrad Med Inst. 2004;18(1):29-32.
11. Shiri R. Hypothyroidism and carpal tunnel syndrome: a metaanalysis. Muscle Nerve. 2014;50(6):879-83. doi: 10.1002/
mus.24453. [PubMed: 25204641].
12. Padua L, Di Pasquale A, Pazzaglia C, Liotta GA, Librante A, Mondelli M. Systematic review of pregnancy-related carpal
tunnel syndrome. Muscle Nerve. 2010;42(5):697-702. doi:10.1002/mus.21910. [PubMed: 20976778].
13. Tang X, Zhuang L, Lu Z. Carpal tunnel syndrome: a retrospective analysis of 262 cases and a one to one matched
case-control study of 61 women pairs in relationship between manual housework and carpal tunnel syndrome. Chin Med J.1999;112(1):44-8. [PubMed: 11593640].
14. Baysal O, Altay Z, Ozcan C, Ertem K, Yologlu S, Kayhan A. Comparison of three conservative treatment protocols in
carpal tunnel syndrome. Int J Clin Pract. 2006;60(7):820-8. doi:10.1111/j.1742-1241.2006.00867.x. [PubMed: 16704676].
15. Ly-Pen D, Andréu JL, Millán I, de Blas G, Sánchez-Olaso A. Comparison of surgical decompression and local steroid
injection in the treatment of carpal tunnel syndrome: 2-year clinical results from a randomized trial. Rheumatology.
2012;51(8):1447-54. doi: 10.1093/rheumatology/kes053
16. Mohamed FI, Hassan A, Abdel-Magied R, Wageh R. Manual therapy intervention in the treatment of patients with carpal tunnel syndrome: median nerve mobilization versus medical treatment. Egypt Rheumatol Rehabil. 2016;43(1):27.
17. Scholten RJ, Gerritsen AA, Uitdehaag BM, van Geldere D, de Vet HC, Bouter LM. Surgical treatment options for carpal tunnel syndrome. Cochrane Database Syst Rev. 2004;4:CD003905. doi:10.1002/14651858.CD003905.pub2. [PubMed: 15495070].
18. Ren YM, Wang XS, Wei ZJ, Fan BY, Lin W, Zhou XH, et al. Efficacy, safety, and cost of surgical versus nonsurgical
treatment for carpal tunnel syndrome: a systematic review and meta-analysis. Medicine. 2016;95(40):e4857. doi:
10.1097/MD.0000000000004857. [PubMed: PMC5059040].
19. Werner RA, Andary M. Carpal tunnel syndrome: pathophysiology and clinical neurophysiology. Clin Neurophysiol. 2002; 113(9):1373-81. [PubMed: 12169318] 
Razavi International Journal of Medicine
Volume 6, Issue 3
July 2018
Pages 21-25

Files

Share

How to cite

Statistics