TY - JOUR T1 - Comparison of pulsed radiofrequency and steroid injection in the treatment of carpal tunnel syndrome guided by USG imaging TT - USG görüntüleme rehberliğinde karpal tünel sendromu tedavisinde pulsed radyofrekans ile steroid enjeksiyonunun karşılaştırılması AU - Boğa, Zeki AU - Saraç, Mustafa Emre PY - 2025 DA - August Y2 - 2025 DO - 10.47582/jompac.1747756 JF - Journal of Medicine and Palliative Care JO - J Med Palliat Care / JOMPAC / jompac PB - MediHealth Academy Yayıncılık WT - DergiPark SN - 2717-7505 SP - 388 EP - 395 VL - 6 IS - 4 LA - en AB - Aims: The research evaluated the effectiveness between ultrasonography-guided pulsed radiofrequency treatment and steroid injection therapy for carpal tunnel syndrome.Methods: The research included 60 patients who received carpal tunnel syndrome diagnoses. The patients received their treatment based on two distinct approaches which formed separate groups: 30 patients who underwent ultrasonography-guided injection of 40 mg methylprednisolone acetate and 30 patients who underwent ultrasonography-guided application of pulsed radiofrequency targeting the median nerve at 42°C for 120 seconds. Visual Analog Scale (VAS) score, Boston Carpal Tunnel Scale and physical examination findings were evaluated before treatment, at 1, 3 and 6 months. All patients underwent EMG before the procedure and at 6 months. Results: At baseline, no significant variations were observed across groups regarding demographic characteristics as well as clinical parameters. At the third month, the VAS score decreased to 2.9±1.5 in the RF group while it was still 3.8±2.1 in the steroid group (p=0.048). Functional scores of the Boston scale were 1.6±0.7 in the pulsed radiofrequency group and 2.0±0.8 in the steroid group (p=0.037). In the electrophysiologic evaluation at the sixth month, motor distal latency was 3.9±0.7 ms in the RF group versus 4.3±0.8 ms in the steroid group (p=0.041). The rate of more than 50% improvement in VAS score was 80% in the RF group compared to 60% in the steroid group. Conclusion: Pulsed radiofrequency therapy delivers superior long-term results than steroid injection does. As a minimally invasive method, it should be evaluated before surgery. KW - Carpal tunnel syndrome KW - median nerve KW - pulsed radiofrequency treatment KW - corticosteroid injection KW - ultrasonography N2 - Amaç: Karpal tünel sendromunun tedavisinde ultrasonografi kılavuzluğunda pulsed radyofrekans ve steroid enjeksiyonunun etkinliğini karşılaştırmak amaçlandı.Yöntem: Bu retrospektif çalışmaya karpal tünel sendromu tanısı alan 60 hasta dahil edildi. Hastalar tedavi yöntemine göre iki gruba ayrıldı: 30 hastaya ultrasonografi kılavuzluğunda 40 mg metilprednizolon asetat enjeksiyonu, 30 hastaya ise ultrasonografi kılavuzluğunda 42°C'de 120 saniye süreyle median sinire pulsed radyofrekans uygulandı. VAS skoru, Boston Karpal Tünel Ölçeği, fizik muayene bulguları ve elektrofizyolojik parametreler tedavi öncesi, 1, 3 ve 6. aylarda değerlendirildi.Sonuçlar: Başlangıçta, gruplar arasında demografik özellikler ve klinik parametreler açısından fark yoktu. Üçüncü ayda, VAS skoru pulsed radyofrekans grubunda 2,9±1,5'e düşerken, steroid grubunda 3,8±2,1 olarak kaldı (p=0,048). Boston ölçeğinin fonksiyonel skorları pulsed radyofrekans grubunda 1,6±0,7, steroid grubunda 2,0±0,8 idi (p=0,037). Altıncı ayda yapılan elektrofizyolojik değerlendirmede, motor distal latensi pulsed radyofrekans grubunda 3,9±0,7 ms ve steroid grubunda 4,3±0,8 ms idi (p=0,041). VAS skorunda %50'den fazla iyileşme oranı pulsed radyofrekans grubunda %80 ve steroid grubunda %60 idi.Sonuç: Pulsed radyofrekans tedavisi, steroid enjeksiyonuna göre uzun vadede daha üstün sonuçlar vermektedir. Minimal invaziv bir yöntem olarak, cerrahi öncesi değerlendirilmelidir. CR - Osiak K, Elnazir P, Walocha JA, Pasternak A. Carpal tunnel syndrome: state-of-the-art review. Folia Morphol (Warsz). 2022;81(4):851-862. doi: 10.5603/FM.a2021.0121 CR - Wietemborek PT, Kacprzak-Czapiewska K, Bartoszuk A, Kułakowski A. Carpal tunnel syndrome conservative treatment: a literature review. Adv Psychiatry Neurol. 2022;31(4):85-94. doi:10.5114/apn.2022.116889 CR - Hernández-Secorún M, Montaña-Cortés R, Hidalgo-García C, et al. Effectiveness of conservative treatment according to severity and systemic disease in carpal tunnel syndrome: a systematic review. Int J Environ Res Public Health. 2021;18(5):2365. doi:10.3390/ijerph18052365 CR - Malakootian M, Soveizi M, Gholipour A, Oveisee M. Pathophysiology, diagnosis, treatment, and genetics of carpal tunnel syndrome: a review. Cell Mol Neurobiol. 2023;43:1817-1831. doi:10.1007/s10571-021-01297-2 CR - Rotaru-Zavaleanu AD, Lungulescu CV, Bunescu MG, et al. Occupational carpal tunnel syndrome: a scoping review of causes, mechanisms, diagnosis, and intervention strategies. Front Public Health. 2024;12:1407302. doi:10.3389/fpubh.2024.1407302 CR - Sivera V, Fani G, Fai A, et al. Safety and efficacy of ultrasound-guided perineural hydrodissection as a minimally invasive treatment in carpal tunnel syndrome: a systematic review. J Pers Med. 2024;14(2):154. doi: 10.3390/jpm14020154 CR - Joshi A, Patel K, Shridevi SU, Varakantam V, Nagula P. Carpal tunnel syndrome: a review of the literature on the prevalence, diagnosis, and treatment. Cureus. 2022;14(7):e27053. doi:10.7759/cureus.27053 CR - Tanrıverdi M, Hoşbay Z, Candan Algun Z. The relationship of pain on the upper extremity functions and quality of life in patients with carpal tunnel syndrome. J Back Musculoskelet Rehabil. 2019;32(1):71-76. doi: 10.3233/BMR-171097 CR - Sarilar AÇ, Gök DK. Value of Boston Questionnaire in Carpal Tunnel Syndrome. Neurol Sci Neurophysiol. 2021;38(4):245-249. doi:10.4103/nsn.nsn_82_21 CR - Tanrıverdi M, Hoşbay Z, Candan Algun Z. The relationship of pain on the upper extremity functions and quality of life in patients with carpal tunnel syndrome. J Back Musculoskelet Rehabil. 2019;32(1):71-76. doi: 10.3233/BMR-171097 CR - Cetinkaya F, Karabulut N. Validity and reliability of the Turkish version of the Visual Analog Sleep Scale. Kontakt. 2016;18(2):e84-89. doi:10. 1016/j.kontakt.2016.05.003 CR - Ullah U, Ahmad A, Shah S, et al. Exploring gender disparities in carpal tunnel syndrome: a comparative analysis of male-female ratios. Pak J Neurol Surg. 2024;28(2):177-183. doi:10.36552/pjns.v28i2.581 CR - Hulkkonen S, Shiri R, Auvinen J, et al. Risk factors of hospitalization for carpal tunnel syndrome among the general working population. Scand J Work Environ Health. 2020;46(1):43-49. doi:10.5271/sjweh.3835 CR - Mathew AE, John T. A clinical and neurophysiological analysis of idiopathic carpal tunnel syndrome with respect to gender and occupation. Ann Indian Acad Neurol. 2021;24(6):865-872. doi:10.4103/aian.AIAN_148_21 CR - Nowak W, Znamirowska P, Szmigielska N, et al. Risk factors for carpal tunnel syndrome in patients with diabetes mellitus. J Pre-Clin Clin Res. 2023;12(2):1-6. doi:10.26444/jpccr/163676 CR - Krzywdzak A, Wryych-Slusarska A, Krupa-Kotera K, et al. Bipolar pulsed radiofrequency neuromodulation of median nerve for treatment of carpal tunnel syndrome-a preliminary study. Ann Acad Med Stetin. 2021;75:107-110. doi:10.18388/ams.2021_75_107-110 CR - Hofer M, Ranstam J, Atroshi I. Extended follow-up of local steroid injection for carpal tunnel syndrome: a randomized clinical trial. JAMA Netw Open. 2021;4(10):e2130753. doi:10.1001/jamanetworkopen.2021. 30753 CR - Gupta H, Vance C, Bansal V, Siva A. A narrative review of pulsed radiofrequency for the treatment of carpal tunnel syndrome. Pain Pract. 2024;24(3):374-382. doi:10.1111/papr.12929 CR - Chan PYW, Santana A, Alter T, et al. Long-term efficacy of corticosteroid injection for carpal tunnel syndrome: a systematic review. HAND. 2023; 20(3):463-473. doi:10.1177/15589447231222320 CR - Ly-Pen D, Andreu JL, Millán I, et al. Long-term outcome of local steroid injection versus surgery in carpal tunnel syndrome: observational extension of a randomized clinical trial. Hand (N Y). 2022;17(4):639-645. doi:10.1177/1558944720944263 CR - Gonu P, Butulu GC, Verma GG, et al. Effectiveness of ultrasound-guided local steroid injection to the wrist for the treatment of carpal tunnel syndrome: is it worth it? Egypt Rheumatol Rehabil. 2022;49:21. doi:10.1186/s43166-022-00121-5 CR - Chakk R, Haskova J, Kautzner J. Autonomic changes are more durable after radiofrequency than pulsed electric field pulmonary vein ablation. JACC Clin Electrophysiol. 2022;8(7):894-904. doi:10.1016/j.jacep.2022. 04.017 CR - Carmo JD. 'INSIGHT-PRECISION': a new, mini-invasive technique for the surgical treatment of carpal tunnel syndrome. J Int Med Res. 2020; 48(2):1-16. doi:10.1177/0300060519874186 CR - Kamel SI, Freid B, Pomeranz C, Halpern EJ, Nazarian LN. Minimally invasive ultrasound-guided carpal tunnel release improves long-term clinical outcomes in carpal tunnel syndrome. AJR Am J Roentgenol. 2021;217(2):460-468. doi:10.2214/AJR.20.24585 CR - Alimohammadi E, Bagheri SR, Hadidi H, Rizevandi P, Abdi A. Carpal tunnel surgery: predictors of clinical outcomes and patients' satisfaction. BMC Musculoskeletal Disord. 2020;21:51. doi:10.1186/s12891-020-3082-2 CR - Mertz K, Ho SAL, Mertz K, Kamal RN. Outcome measures in carpal tunnel syndrome: a systematic review. HAND (N Y). 2022;17(4):660-667. doi:10.1177/1558944720949951 UR - https://doi.org/10.47582/jompac.1747756 L1 - https://dergipark.org.tr/en/download/article-file/5077497 ER -