Clinical Effect And Ultrasonography Evaluation Of Oral Administration And Local Injection Of Steroid In Patients With Carpal Tunnel Syndrome

Objective:The treatment methods of carpal tunnel syndrome(CTS)are lack of large sample randomized controlled trials,and the effectiveness are not entirely clear.The purpose of this study is to investigate the clinical effect of steroid in treatment of patient with CTS using clinical scores and ultrasonography.Methods:A total of 42 patients with CTS who met the inclusion criteria were enrolled consecutively from August 2015 to July 2016 and divided according to the number of enrollment The inclusion criteria were the patients who had clinical manifestations of CTS,and confirmed by electrophysiology.According to the group number,patients were randomly divided into two groups.The patient with odd numbers were given oral steroid(oral group)and the patient with even numbers were given local injection of steroid(injection group).The degree of electrophysiological abnormalities was classified as mild,moderate,severe and extremely severe for all patients before treatment.Determination of clinical scores and high-frequency ultrasound examination were performed before treatment and at 1 month after treatment The clinical scores include the CTS Global Symptom Score(GSS),Boston Symptom Severity Scale(SSS),and Functional Status Scale(FSS).High-frequency ultrasound transverse scan was performed to measure the cross-sectional area(CSA)of the median nerve,including the carpal tunnel entrance,central carpal tunnel,carpal tunnel exit,and forearm(CSA1,CSA 2,CSA 3,CSA 4,respectively),and longitudinal scan was performed to measure the diameter of the finest and largest section(D1,D2,respectively).The difference(?)and ratio(R)of the parameters were calculated before and after the treatment were calculated.Results:1.A total of 62 consecutive patients were included in one year,including 57 females and 5 males,with 108 wrists involved.There were 20 patients excluded,including 2 patients with diabetes mellitus,1 with ankylosing spondylitis,2 with total hysterectomy,6 with irregular medication,7 with lost follow-up.Finally 42 patients were enrolled for the study,in which 22 patient with odd numbers were given oral steroid(oral group)and the 20 with even numbers were given local injection of steroid(injection group).The gender and age of two groups were matched(P>0.05).2.After treatment,both groups had significant reductions in the clinical scores of GSS,SSS,and FSS and the ultrasonic parameters CSA1,CSA2,CSA3,D,and R-CSA(P<0.05).3.The injection group had significantly higher ?CSA1 and AR-CSA than the oral group(P<0.05).4.In the patients with mild and moderate CTS,the injection group had significantly higher?CSA1 and ?AR-CSA than the oral group(P<0.05),while in the patients with severe and extremely severe CTS,there were no significant differences in these parameters between two groups(P>0.05).Conclusions:In the patients with mild and moderate CTS,whether oral or local injected of steroid at the carpal tunnel have a short-term effect,and local injected of steroid was better than oral administration.Ultrasonography evaluation has clinical significance in evaluating the clinical effect,and the parameter of ?CSA1 was most meaningful,combined with ?R-CSA can better assess the clinical effect.