Comparison of Ultrasound-Guided Injection With Traditional Median Nerve Decompression Surgery in Patients With Carpal Tunnel Syndrome: Randomized Controlled Study
概览
- 阶段
- 不适用
- 干预措施
- Minimal Incision Surgery for median nerve decompression
- 疾病 / 适应症
- Musculoskeletal Diseases
- 发起方
- Afyonkarahisar Health Sciences University
- 入组人数
- 60
- 试验地点
- 1
- 主要终点
- Change from baseline visual analog scale (VAS) wrist pain at 4th and 12th week
- 状态
- 招募中
- 最后更新
- 上个月
概览
简要总结
The aim of this study is to compare ultrasound-guided perineural injection of the median nerve with classic minimal incision surgical technique for median nerve decompression in patients diagnosed with mild, moderate, and severe carpal tunnel syndrome.
详细描述
Carpal tunnel syndrome represents the most prevalent type of entrapment neuropathy. Anatomically, the carpal tunnel is formed by the carpal bones and lies beneath the transverse carpal ligament, housing nine tendon sheaths of the forearm flexors along with the median nerve. From a clinical perspective, individuals with carpal tunnel syndrome typically experience sensory symptoms such as paresthesia and hypoesthesia, as well as motor impairments and pain within the region supplied by the median nerve, all resulting from mechanical compression and localized ischemia. In the classification of CTS, participants are diagnosed with mild, moderate, or severe CTS, and various treatment options are available for each category. Treatment options aimed at alleviating symptoms include physical therapy, splinting, wrist injections, and surgical procedures Ultrasound-guided injections of peripheral nerves are typically more advantageous than blind injections because minimize the risk of damaging crucial vascular structures in the adjacent tissue alongside the nerves and decrease the likelihood of intraneural injections. CTS can also be treated surgically, although the literature has not provided sufficient evidence to establish the superiority of one surgical technique over another. However, these procedures are known to be effective by reducing the volume of the carpal tunnel, thereby relieving pressure on the median nerve. In CTS surgery, following a mini-incision, the dissection proceeds through fat and fascial tissue until the flexor retinaculum is reached, ensuring decompression of the median nerve. The advantages of the mini-incision technique include the preservation of neurovascular structures, a low risk of complications, and a high level of patient satisfaction, making it a prominent surgical approach. The aim of this study is to compare ultrasound-guided perineural injection of the median nerve with the classic minimal incision surgical technique for median nerve decompression in participants diagnosed with mild, moderate, and severe carpal tunnel syndrome.
研究者
Nuran Eyvaz
Asistant Profesor
Afyonkarahisar Health Sciences University
入排标准
入选标准
- •The presence of symptoms such as nocturnal, posture-related, or movement-related paresthesias, along with possible pain, in the area supplied by the median nerve in the hand, lasting for more than 3 months.
- •Confirmation of mild, moderate or severe CTS through electrophysiological testing.
- •Numbness and loss of sensation in the hand's regions innervated by the median nerve, as well as weakness in the thenar muscles innervated by the median nerve.
- •Positive results on either the Phalen test and/or Tinel sign.
排除标准
- •Individuals who may exhibit symptoms mimicking carpal tunnel syndrome, such as cervical radiculopathy, polyneuropathy, brachial plexopathy, or thoracic outlet syndrome.
- •Patients who have received a previous injection into the carpal tunnel within the past 6 months.
- •Thenar muscle atrophy.
- •A history of prior carpal tunnel surgery.
- •Regular usage of systemic nonsteroidal anti-inflammatory drugs and corticosteroids.
- •Pregnancy
- •Patients diagnosed with rheumatoid arthritis, systemic lupus erythematosus, gout, systemic sclerosis, dermatomyositis, or polymyositis.
- •Malignancy.
- •Active infections
研究组 & 干预措施
Minimal Incision Surgery for median nerve decompression
Classic minimal incision surgical technique for median nerve decompression in patients diagnosed with mild, moderate, and severe carpal tunnel syndrome.
干预措施: Minimal Incision Surgery for median nerve decompression
Ultrasound-guided perineural injection with 5 cc 5% Dextrose
The median nerve will be identified using ultrasound at the proximal entrance of the carpal tunnel. Using an ulnar approach with the in-plane technique, it was planned to inject 5 cc of 5% dextrose around the median nerve.
干预措施: Ultrasound-guided perineural injection with 5 cc 5% Dextrose
结局指标
主要结局
Change from baseline visual analog scale (VAS) wrist pain at 4th and 12th week
时间窗: baseline and 12th week
Pain intensity was assessed using a visual analogue scale for pain, ranging from 0 to 10 mm, where 0 indicates the absence of pain and 10 signifies intense pain. This scale is widely recognized for its strong reliability and validity in measuring musculoskeletal pain.
次要结局
- Change from baseline Cross-sectional area of the Median Nerve (CSA) at 4th and 12th week(baseline and 12th week)
- Change from baseline Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) at 4th and 12th week(baseline and 12th week)
- Change from baseline Hand Grip Strength Assessment at 4th and 12th week(baseline and 12th week)
- Change from baseline Electrophysiological Evaluation at 4th and 12th week(baseline and 12th week)
- Change from baseline Finger Grip Strength Assessment at 4th and 12th week(baseline and 12th week)