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

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 1* Sağlık Bilimleri Üniversitesi, İstanbul EAH, Anesteziyoloji ve Yoğun Bakım Kliniği, Sorumlu Yazar /Corresponding author: serpilsahin@gmail.com, ORCID: https://orcid.org/0000-0003-1471-1340 2 Sağlık Bilimleri Üniversitesi, İstanbul EAH, Anesteziyoloji ve Yoğun Bakım Kliniği, ORCID: https://orcid.org/0000-0003-1316-7160 3 Sağlık Bilimleri Üniversitesi, İstanbul EAH, Anesteziyoloji ve Yoğun Bakım Kliniği, ORCID: https://orcid.org/0000-0002-5488-3399 4 Sağlık Bilimleri Üniversitesi, İstanbul EAH, Anesteziyoloji ve Yoğun Bakım Kliniği, ORCID: https://orcid.org/0000-0002-6480-5356 Makale Geliş Tarihi / Received: 25.9.2019 – Makale Kabul Tarihi / Accepted: 5.10.2019 Özgün Araştırmalar (Original Research) Karpal Tünel Sendromu Tedavisinde Median Sinirin Darbeli Radyofrekans Lezyonuyla Birlikte Ultrason Eşliğinde Steroid Enjeksiyonu Etkili mi? 44 severity as determined by the Boston Carpal Tunnel Questionnaire (BCTQ). Our results indicate that although there was no significant difference at 12th week between the groups according to electromyographic (EMG) findings, the functional status and symptom severity as measured by the BCTQ were worse in Group S+RF than in Group S.