Is Ultrasound-Guided Steroid Injection With Pulsed Radiofrequency Lesioning of The Median Nerve Effective For Treatment of Carpal Tunnel Syndrome?

Year 2020, Volume: 6 Issue: 1, 43 - 55, 02.02.2020

Serpil Şehirlioğlu Onat Akyol Alican Açıkgöz Emine Nur Tozan

Abstract

Carpal tunnel syndrome (CTS), a condition occurring in 0.1% of the general population, develops as the result of median nerve compression in the carpal tunnel of the wrist, usually because of tenosynovitis of the flexor tendons. We aimed to compare pulsed-mode radiofrequency lesioning of the median nerve to repetitive local steroid injections under ultrasound guidance (USG) for the treatment of CTS. Two groups were treated, each of 25 patients with a diagnosis of moderate CTS, referred to in this study as Group Steroid (Group S) and Group Radiofrequency (Group S+RF). Both groups received an injection of 1 ml 0.5% levobupivacaine mixed with 1 ml betamethasone into the carpal tunnel under USG. Four weeks later, Group S received a local steroid injection together with the same initial dose, and Group S+RF received pulsed-mode radiofrequency. All procedures were applied under the USG(Esaote® MyLab Five, Netherlands) by the same doctor (Dr Sehirlioglu) Boston Carpal Tunnel Questionnaire (BCTQ) and electromyographic evaluation were applied to all patients on their first visit and 12 weeks later. At the 12th week, changes of the electrophysiological parameters of the median nerve were recorded for both groups, including motor and sensorial conduction velocity, functional capacity and symptom

Keywords

Carpal tunnel, pain, radiofrequency, median nerve, usg

References

• Stevens JC, Sun S, Beard CM, O’Fallon WM, Kurland LT. Carpal tunnel syndrome in Rochester Minnesota, 1961 to 1980. Neurology. 1988; 38: 134–138.
• Gerritsen AA, de Krom MC, Struijs MA, Scolten RJ, de Vet HC, Bouter LM. Conservative treatment options for carpal tunnel syndrome: a systematic review of randomised controlled trials. J Neurol. 2002; 249: 272–280.
• Graham B. Nonsurgical treatment of carpal tunnel syndrome. J Hand Surg Am. 2009; 34: 531–534.
• Dammers JW, Veering MM, Vermeulen M. Injection with methylprednisolone proximal to the carpal tunnel: randomised double blind trial. BMJ. 1999; 319: 884–886.
• Verdugo RJ, Salinas RA, Castillo JL, Cea JG. Surgical versus non- surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev. 2008. p. CD001552.
• Munglani R. The longer term effect of pulsed radiofrequency for neuropathic pain. Pain. 1999; 80: 437–439.
• Haider N, Mekasha D, Chiravuri S, Wasserman R. Pulsed radiofrequency of the median nerve under ultrasound guidance. Pain Physician. 2007; 10: 765–770.
• Marhofer P, Chan VW. Ultrasound-guided regional anesthesia: current concepts and future trends. Anaesth Analg. 2007; 104: 1265–1269.
• Wong SM, Griffith JF, Hui AC, Lo SK, Fu M, Wong KS. Carpal tunnel syndrome: diagnostic usefulness of sonography. Radiology. 2004; 232: 93–99.
• Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, Katz JN. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. Journal of Bone & Joint Surgery - American Volume. 1993;75:1585–1592.
• Leite JC, Jerosch-Herold C, Song F. A systematic review of the psychometric properties of the Boston Carpal Tunnel Questionnaire. BMC Musculoskelet Disord. 2006 Oct 20; 7: 78.
• Berger M, Vermeulen M, Koelman JH, van Schaik IN, Roos YB. The long-term follow-up of treatment with corticosteroid injections in patients with carpal tunnel syndrome. When are multiple injections indicated? J Hand Surg Eur. 2012 Vol. 6
• Lee JH, An JH, Lee SH, Hwang EY. Effectiveness of steroid injection in treating patients with moderate and severe degree of carpal tunnel syndrome measured by clinical and electrodiagnostic assessment. Clin J Pain. 2009 Feb; 25(2):111–115.
• Cartwright MS, Hobson-Webb LD, Boon AJ, Alter KE, Hunt CH, Flores VH, Werner RA, Shook SJ, Thomas TD, Primack SJ, Walker F. Evidence-based guideline: neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome. Muscle Nerve. 2012 Aug; 46(2): 287–293.
• Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev. 2009; (2): CD001554.
• O’Connor D, Marshall S, Massy-Westropp N. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev. 2003; 1: CD003219.
• Chen LC, Ho CW, Sun CH, Lee JT, Li TY, Shih FM, Wu YT. Ultrasound-Guided Pulsed Radiofrequency for Carpal Tunnel Syndrome: A Single-Blinded Randomized Controlled Study. PLoS One. 2015 Jun 12;10(6):e0129918
• Malik K, Benzon HT. Pulsed radiofrequency: a critical review of its efficacy. Anaesth Intensive Care. 2007 Dec; 35(6): 863–873.
• Byrd S, Mackey S. Pulsed radiofrequency for chronic pain. Curr Pain Headache Rep. 2008 January; 12(1): 37–41.