Image-guided procedure provides lasting relief for carpal tunnel syndrome
A minimally invasive, image-guided procedure can provide lasting relief for carpal tunnel syndrome, according to new research published in RSNA’s Radiology.
This common occupational ailment is frequently encountered among the middle-aged, leading to morbidity and loss of work hours. Common carpal tunnel syndrome management strategies may include conservative therapy or surgical decompression, experts note.
However, image-guided interventions such as steroid shots or nerve hydrodissection—which involves carefully injecting fluid around the impacted area—have emerged as alternatives for mild to moderate cases. Researchers in India recently aimed to investigate the efficacy of these options, sharing their findings Tuesday.
“Most of our patients had been suffering from carpal tunnel syndrome for months to years and did not get much relief despite trying various treatments like pain medications, splints, lifestyle modification and corticosteroids,” study co-author Anupama Tandon, MD, a professor with the University College of Medical Sciences and Guru Teg Bahadur Hospital in Delhi, India, said in a statement Oct. 6. “It came as a pleasant surprise to find that a simple procedure of dissecting the median nerve under ultrasound guidance with normal saline provided them long-term relief.”
The investigation included 39 participants with recurrent carpal tunnel syndrome, randomized to receive 1 of 3 different ultrasound-guided treatment techniques. Two groups underwent hydrodissection of the median nerve, with one receiving normal saline alone, while the other group got a combination of saline and corticosteroids. And finally, the third received an image-guided steroid injection alone. Tandon and colleagues assessed patients using standardized symptom, functional and pain scores. They also checked the median nerve area using ultrasound at four, 12 and 24 weeks after treatment.
All three groups experienced significant improvement at the one-month mark. However, the benefits of nerve hydrodissection persisted, with patients’ condition continuing to improve over the subsequent follow-up periods. Adding steroids to the hydrodissection injectate did not provide measurable added benefit when compared to just saline. Steroids also can come with side effects that include localized skin changes, fat thinning and tendon weakening, the authors noted.
“At 12 weeks and 6 months, both hydrodissection groups demonstrated further improvement in clinical symptoms and function, whereas patients who received corticosteroid injection alone experienced a recurrence of the symptoms, suggesting that the initial benefit was short-lived,” Tandon said.
Ultrasound findings further supported the study’s results. Imaging showed that the cross-sectional area of the median nerve decreased by about 43% to 45% after hydrodissection. This compared to about 15% following corticosteroid injection alone, signaling a greater reduction in nerve swelling.
Experts see opportunity for radiology groups in treating this patient population. Carpal tunnel syndrome affects about 5% to 10% of the general population over their lifetimes, and incidence rates appear to be rising. Plus, the procedure takes only 15 minutes on average, with patients tolerating it well in the study. No significant immediate or delayed complications were observed, and follow-up questionnaires showed that patients were highly satisfied.
These injections also are low-cost and do not require anesthesia nor hospitalization, with patients able to return to work within an hour.
“These findings support the concept that hydrodissection contributes substantially to therapeutic efficacy in [carpal tunnel syndrome], irrespective of the pharmacologic properties of the injectate,” the authors concluded.
Tandon and colleagues warn that further multicenter studies, with larger cohorts and longer follow-up periods, are warranted. The authors have already launched another investigation comparing the long-term impact of different injectates.
Read more about the results in the flagship journal of the Radiological Society of North America.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.