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Ultraschall Med 2018; 39(03): 334-342
DOI: 10.1055/s-0043-120109
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Ultrasound-Guided Corticosteroid Injection in Patients with Carpal Tunnel Syndrome: Efficacy of Intra-Epineurial Injection

Ultraschallgesteuerte Kortikosteroid-Injektion bei Patienten mit Karpaltunnelsyndrom: Wirksamkeit der intraepineuralen Injektion
Yi-Chih Hsu
1   Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
,
Fu-Chi Yang
2   Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
,
Hsian-He Hsu
1   Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
,
Guo-Shu Huang
1   Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
3   Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
› Author Affiliations
Further Information

Publication History

01 March 2017

13 September 2017

Publication Date:
28 December 2017 (online)

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Abstract

Purpose To identify the ultrasound (US) findings of intra-epineurial corticosteroid injection during US-guided hydrodissection in patients with carpal tunnel syndrome (CTS), and to determine their clinical relevance in relation to treatment outcomes.

Materials and Methods We performed 101 US-guided hydrodissections and corticosteroid injections in 101 patients with CTS, and evaluated their pre- and post-injection US findings. We categorized these injections into two groups based on the occurrence of intra-epineurial injection. We also recorded clinical data including sex, age, side of injection, BMI, and the duration of pre-injection CTS-related discomfort. The outcomes were measured using the Likert satisfaction scale and Boston Carpal Tunnel Questionnaire (BCTQ) scores. The clinical data, cross-sectional area of the median nerve (CSA-MN) at the inlet of the carpal tunnel measured on US images, and the symptom relief for the patients receiving intra-epineurial and extra-epineurial injection were compared.

Results The intra-epineurial injection rate was 38.6 % in the 101 US-guided injections. The clinical data, pre-injection CSA-MN at the inlet of the carpal tunnel, and pre-injection BCTQ scores showed no significant intergroup differences (p > 0.05). The group with intra-epineurial injections had significantly decreased CSA-MN (difference in means, 2.5 mm2; p < 0.0001), greater patient satisfaction (p = 0.002), and lower BCTQ scores (p < 0.05) than the group with extra-epineurial injections.

Conclusion We characterized the US findings of intra-epineurial corticosteroid injection during US-guided hydrodissection. Intra-epineurial injection provided a more meaningfully reduction in edema of the MN, greater patient satisfaction, and greater symptom relief than extra-epineurial injection.

Zusammenfassung

Ziel Ermittlung der sonographischen (US) Befunde der intraepineuralen Kortikosteroid-Injektion während der US-geführten Hydrodissektion bei Patienten mit Karpaltunnelsyndrom (CTS) und deren klinischer Bedeutung in Hinblick auf die Behandlungsergebnisse.

Material und Methoden Wir führten 101 US-gesteuerte Hydrodissektionen und Kortikosteroid-Injektionen bei 101 Patienten mit CTS durch und beurteilten deren US-Befunde vor und nach Injektion. Wir haben diese Injektionen in zwei Gruppen eingeteilt, basierend auf der Durchführung der intraepineuralen Injektion. Darüber hinaus vermerkten wir klinische Daten wie Geschlecht, Alter, Injektionsseite, BMI und der Zeitdauer des Bestehens der CTS-bedingten Beschwerden vor Injektion. Die Ergebnisse wurden mittels der Likert-Zufriedenheitsskala und dem „Boston Carpal Tunnel Questionnaire“ (BCTQ) erhoben. Die klinischen Daten, die sonografisch bestimmte Querschnittsfläche des N. medianus (CSA-MN) am Eingang des Karpaltunnels und die Linderung der Symptome wurde für die Patienten, die intraepineurale und extraepineurale Injektion erhielten, verglichen.

Ergebnisse Die intraepineurale Injektionsrate betrug bei den 101 US-gesteuerten Injektionen 38,6 %. Die klinischen Daten, CSA-MN vor Injektion am Eingang des Karpaltunnels und die BCTQ-Scores vor Injektion zeigten keine signifikanten Intergruppenunterschiede (p > 0,05). Die Gruppe mit intraepineuralen Injektionen hatte signifikant gesenkte CSA-MN (Differenz der Mittelwerte: 2,5 mm2; p ≤ 0,0001), eine höhere Patientenzufriedenheit (p = 0,002) und niedrigere BCTQ-Scores (p ≤ 0,05) als die Gruppe mit extraepineuralen Injektionen.

Schlussfolgerung Wir charakterisierten die US-Befunde der intraepineuralen Kortikosteroid-Injektion während der US-gesteuerten Hydrodissektion. Die intraepineurale Injektion führte - im Gegensatz zur extraepineuralen Injektion - zu einer deutlicheren Reduktion des Ödems des MN, zu einer größeren Patientenzufriedenheit und zu einer stärkeren Linderung der Symptome.

Key words

carpal tunnel syndrome - corticosteroid - epineurium - injection - ultrasound guidance
 

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