Ann Rehabil Med.  2011 Jun;35(3):388-394. 10.5535/arm.2011.35.3.388.

Usefulness of Ultrasonography to Predict Response to Injection Therapy in Carpal Tunnel Syndrome

• Jeong JS
• Yoon JS
• Kim SJ
• Park BK
• Won SJ
• Cho JM
• Byun CW

• KMID: 2266859
• DOI: http://doi.org/10.5535/arm.2011.35.3.388

Abstract

OBJECTIVE
To verify the feasibility of initial parameters of ultrasonography or electromyography for the prediction of effect after steroid injection therapy in a carpal tunnel syndrome (CTS) patient. METHOD: We recruited individuals with clinical and electrodiagnostic evidence of CTS. Results from the Boston self-assessment questionnaire, median motor and sensory nerve conduction studies, and median nerve ultrasonography were evaluated at baseline, 1 month, and 6 months after injection. Evaluation of median nerve ultrasonography parameters included measurements taken at the maximal swelling point (MS), 2 cm proximal from MS (2MS), and 12 cm proximal from MS (12MS), and its ratio (MS/12MS, 2MS/12MS) was calculated. The correlation between improvement of the symptom score after treatment and baseline parameters was estimated.
RESULTS
Fourteen individuals (14 women, mean age 53.8 years) with 22 affected wrists were enrolled. After steroid injection therapy, clinical and electromyographic parameters showed significant improvements at 1 month or 6 months after injection, and ultrasonographic parameters showed significant changes in maximal area and area ratio (MS/12MS) of the median nerve. Symptom score improvement showed a positive correlation in the initial 2MS and ratio of 2MS/12MS after 6 months (p<0.05).
CONCLUSION
Most of the improvements occurred during the first month after injection and lasted up to 6 months. The initial median nerve swelling and its ratio may be a useful predictor of response after steroid injection.

Keyword

Carpal tunnel syndrome; Ultrasonography; Area ratio; Injection; Predictor

MeSH Terms

Boston
Carpal Tunnel Syndrome
Electromyography
Female
Humans
Median Nerve
Neural Conduction
Self-Assessment
Wrist
Surveys and Questionnaires

Figure

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  Fig. 1 (A) Placement of ultrasonographic probe at the forearm. Ultrasonographic transverse scan was done at 3 different levels. We measured the cross sectional area of median nerve at the most swollen site level A, 2 cm proximal to this level B, 12 cm proximal to this level C. We calculated ratio of A/C, B/C. (B) Median nerve transverse sonogram image at A, B, C level.

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  Fig. 2 Transverse sonogram of the carpal tunnel in a patient with idiopathic carpal tunnel syndrome. (A) A 26-gauge needle (arrow) is shown passing from the ulnar aspect of the carpal tunnel to a position adjacent and deep to the median nerve. (B) A 26-gauge needle (arrow) is shown passing from the ulnar aspect of the carpal tunnel to a position adjacent to the median nerve just below flexor retinaculum. MN: Median nerve .

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