Novel Motor-Sparing Ultrasound-Guided Neural Injection in Severe Carpal Tunnel Syndrome: A Comparison of Four Injectates. (17th February 2022)

• Record Type: Journal Article
• Authors: Wu, Yung-Tsan; Lam, King Hei Stanley; Lai, Chia-Ying; Chen, Si-Ru; Shen, Yu-Ping; Su, Yu-Chi; Li, Tsung-Ying; Wu, Chueh-Hung
• Other Names: D'alessandris Quintino Giorgio Academic Editor.
• Is Part Of: BioMed research international. Volume 2022(2022)
• Publication Date: 2022-02-17
• Subjects: Medicine -- Periodicals; Biology -- Periodicals; Biotechnology -- Periodicals; Life sciences -- Periodicals; 610.5
• DOI: 10.1155/2022/9745322
• Languages: English
• ISSNs: 2314-6133

Abstract

Abstract : Nerve hydrodissection uses fluid injection under pressure to selectively separate nerves from areas of suspected entrapment; this procedure is increasingly viewed as potentially useful in treating carpal tunnel syndrome (CTS). The usage of normal saline (NS), 5% dextrose water (D5W), platelet-rich plasma (PRP), and hyaluronic acid (HA) as primary injectates for hydrodissection without an anesthetic can limit anesthetic-related toxicity and preserve the motor functions of the median nerve. Here, we describe a novel motor-sparing neural injection and compare the effect of these four injectates for severe CTS. We retrospectively reviewed the outcomes of 61 severe CTS cases after a single neural injection with NS, D5W, PRP, or HA. Outcomes were evaluated on the 1 st and 6 th months postinjection, including the Boston Carpal Tunnel Questionnaire (BCTQ) scores and the nerve cross-sectional area (CSA). The results revealed that PRP, D5W, and HA were more efficient than NS at all measured time points (p < 0.05 ), except for CSA at the 1 st month between the NS and D5W groups. Single-injections of PRP and D5W seemed more effective than that of HA within 6 months postinjection for symptom and functional improvement (6 th -month BCTQ-symptom, D5W vs. HA, p = 0.047 ; 1 st -month BCTQ-symptom, PRP vs. HA, p = 0.018 ; 1 st - and 6 th -month BCTQ-function, D5W vs. HA, p = 0.002 and 0.016, respectively; 1 st -month BCTQ-function, PRP vs. HA, p < 0.001 ). For reducing CSA, PRP and HA seemed more effective than D5W (HA > PRP > D 5 W on the 1 st month and HA vs. D5W, p = 0.001 ; PRP > HA > D 5 W on the 6 th month and PRP vs. D5W, p = 0.012 ).