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Front Pharmacol 2022 27;13:834213. Epub 2022 Apr 27.

Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.

Recently, there was a series of clinical studies focusing on local injection of platelet-rich plasma (PRP) for treatment of patients with carpal tunnel syndrome (CTS). However, the safety and efficacy of PRP in these CTS patients remains controversial. Therefore, we performed a systematic review to compare PRP with other conservative treatments in treatment of CTS patients. Read More

Life (Basel) 2022 Apr 4;12(4). Epub 2022 Apr 4.

Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074 Aachen, Germany.

Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. This meta-analysis compared local steroid injections (LSIs) versus carpal tunnel release (CTR) for the management of CTS. Neurophysiological parameters, patient-reported outcome measures (PROMs), and the complication rate were investigated. Read More

Plast Reconstr Surg Glob Open 2022 Apr 18;10(4):e4189. Epub 2022 Apr 18.

Section of Plastic Surgery, Michigan Medicine, Ann Arbor, Mich.

Background: The nonsurgical treatment of carpal tunnel syndrome (CTS) consists of multiple modalities: splinting, corticosteroid injections, hand therapy, and oral medications. However, data supporting the effectiveness of these different modalities are varied, thus creating controversy regarding the optimal nonsurgical treatment. It is unknown how current hand surgeons utilize nonsurgical treatments for CTS. Read More

Cureus 2022 Jan 25;14(1):e21591. Epub 2022 Jan 25.

Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Jodhpur, IND.

Introduction Perineural corticosteroid injection is an extensively used and accepted treatment for carpal tunnel syndrome (CTS). However, to this date, there is no guideline as to which corticosteroid has to be used as the standard treatment for CTS. Triamcinolone acetonide is a commonly used particulate steroid that can cause permanent nerve injury if it is accidentally injected into the nerve. Read More

Front Neurol 2021 7;12:782319. Epub 2022 Feb 7.

Department of Rehabilitation, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.

Objective: To investigate the efficacy and safety of ultrasound-guided nerve hydrodissection (HD) with 5% dextrose (D5W) as add-on therapy after corticosteroid injection in carpal tunnel syndrome (CTS), and provide a novel strategy.

Methods: In this retrospective study, patients with CTS who received ultrasound-guided nerve HD with D5W as add-on therapy after corticosteroid injection (combination group) were enrolled. Patients who received corticosteroid injection without add-on therapy (steroid group) were recruited as the control group. Read More

Ir J Med Sci 2022 Jan 17. Epub 2022 Jan 17.

Department of Anesthesiology and Reanimation, Division of Pain Medicine, Faculty of Medicine, Erciyes University, Köşk Mah. Prof. Dr. Turhan Feyzioğlu Cad. No. 42, 38039, Melikgazi, Kayseri, Turkey.

Background: Carpal tunnel syndrome (CTS) is the most widespread form of nerve entrapment neuropathy results from increase compression pressure of the median nerve at the wrist under the transverse carpal ligament.

Aims: To compare ultrasound (US)-guided median nerve steroid injection and pulsed radiofrequency (PRF) on pain intensity, functional status, and patient satisfaction in the treatment of CTS.

Methods: A total of 90 hands of 59 patients who underwent steroid injection at the level of proximal carpal tunnel or PRF for CTS were retrospectively analyzed. Read More

J Hand Surg Am 2021 Nov 25. Epub 2021 Nov 25.

Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University, Goyang, Korea of Republic. Electronic address:

Purpose: Local steroid injection is an effective treatment modality for carpal tunnel syndrome. This study aimed to investigate the success rate of ultrasonography-guided local steroid injection and determine the prognostic value of the cross-sectional area (CSA) of the median nerve for steroid injection.

Methods: We retrospectively evaluated 40 patients with carpal tunnel syndrome whose median nerve CSA was >15 mm (large-CSA group; n = 16) or ≤15 mm (small-CSA group; n = 24). Read More

JAMA Netw Open 2021 10 1;4(10):e2130753. Epub 2021 Oct 1.

Department of Orthopedics, Kristianstad Hospital, Kristianstad, Sweden.

Importance: Local steroid injection is commonly used in treating patients with idiopathic carpal tunnel syndrome, but evidence regarding long-term efficacy is lacking.

Objective: To assess the long-term treatment effects of local steroid injection for carpal tunnel syndrome.

Design, Setting, And Participants: This exploratory 5-year extended follow-up of a double-blind, placebo-controlled randomized clinical trial was conducted from November 2008 to March 2012 at a university hospital orthopedic department. Read More

J Bone Joint Surg Am 2021 10;103(19):1777-1787

Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan.

Background: Carpal tunnel steroid injection is a nonoperative intervention for the treatment for idiopathic carpal tunnel syndrome (CTS). The antifibrotic, anti-inflammatory, and antiedematous properties of steroids account for their therapeutic effects in the context of CTS; however, their relative contribution has not been clarified.

Methods: Fibroblasts from subsynovial connective tissues (SSCT) were intraoperatively collected from patients with idiopathic CTS and were incubated with or without the steroid triamcinolone acetonide (TA) for 1, 3, and 7 days; the expression of fibrosis-related genes and inflammatory cytokines was evaluated using quantitative reverse transcription-polymerase chain reaction. Read More

Rev Esp Cir Ortop Traumatol (Engl Ed) 2021 Aug 5. Epub 2021 Aug 5.

Departamento de Ciencias Médicas y Quirúrgicas, Facultad de Medicina, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España; Servicio de Cirugía Ortopédica y Traumatología, Hospital Perpetuo Socorro, Las Palmas de Gran Canaria, Las Palmas, España.

Background And Objective: Steroid injections are effective in the treatment of trigger digits but the pain during the injection is an always-present accompanying effect. The aim of this study was to assess the effectiveness and perceived pain during an out-of-sheath corticosteroid injection through the dorsal webspace in the treatment of trigger digits.

Material And Method: A total of 126 consecutive patients were included. Read More

J Ultrason 2021 Jun 18;21(85):e169-e176. Epub 2021 Jun 18.

Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Italy.

Ultrasound is a fast, reliable and radiation-free method for the assessment of a wide range of pathological conditions, as well as for the guidance of percutaneous interventional procedures around the elbow, hand and wrist. Intraarticular and periarticular interventional procedures can be easily performed under continuous ultrasound monitoring to ensure correct needle positioning and medication delivery to a specific target. The most common ultrasound-guided procedures performed around the elbow, wrist, and hand are described in this review, excluding carpal tunnel procedures. Read More

Pain Physician 2021 07;24(4):E453-E458

Department of Anesthesia,Intensive Care and Pain Relief, Assiut University, Assiut, Egypt.

Background: Carpal tunnel syndrome (CTS) is the most entrapment syndrome in general and is the most frequent peripheral nervous system involvement in systemic sclerosis (SSc). Local injection of steroid hydrodissection or ozone-oxygen showed favourable outcome in CTS in general.

Objectives: To compare the clinical efficacy of ozone versus methylprednisolone intracarpal injection upon pain, functional status, and nerve conduction in patients with CTS due to SSc. Read More

Hand (N Y) 2021 Jun 9:15589447211017229. Epub 2021 Jun 9.

Emory University, Atlanta, GA, USA.

Background: Recent studies suggest increased complications when surgery closely follows corticosteroid injection. The purpose of this study was to understand the occurrence of surgical site infection (SSI), wound complications, and reoperation rates after carpal tunnel release (CTR) when corticosteroid injections were given within 180 days preoperatively.

Methods: Data were collected from the Truven MarketScan database from 2009 to 2018. Read More

Agri 2021 Apr;33(2):96-102

Department of Neurology, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, İstanbul, Turkey.

Objectives: Carpal tunnel syndrome (CTS) is the most seen entrapment neuropathy. CTS is a complex syndrome arisen with entrapment of median nerve at wrist. Pain worst at night, paresthesia, hypoesthesia, paralysis, and muscle atrophy can be seen through nerve entrapment level. Read More

Front Pharmacol 2020 5;11:621150. Epub 2021 Mar 5.

Division of Pharmacy Practice, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.

Peripheral nerve entrapment syndromes commonly result in pain, discomfort, and ensuing sensory and motor impairment. Many conservative measures have been proposed as treatment, local injection being one of those measures. Now with high-resolution ultrasound, anatomical details can be visualized allowing diagnosis and more accurate injection treatment. Read More

BMJ Case Rep 2021 Jan 18;14(1). Epub 2021 Jan 18.

Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

A 65-year-old man presented with generalised erythematous pustular rash following an insect bite. He was initially treated with antibiotics for presumed cellulitis. He subsequently developed bilateral carpal tunnel syndrome. Read More

J Hand Surg Am 2021 02 31;46(2):92-98. Epub 2020 Oct 31.

Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI; Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI; Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI. Electronic address:

Purpose: Our study aimed to evaluate the relationship between electrodiagnostic study (EDS) severity and utilization of treatments for carpal tunnel syndrome (CTS) as well as the duration of time between EDS and carpal tunnel release (CTR).

Methods: We conducted a retrospective medical chart review at a single tertiary hand center to evaluate CTS-related care that patients received after EDS. We recorded patient age, sex, race/ethnicity, insurance type, CTS-related surgical and nonsurgical healthcare utilization after EDS testing, and number of days between EDS and CTR. Read More

Sci Rep 2020 09 24;10(1):15607. Epub 2020 Sep 24.

Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunghwndo-ro, Dong-gu, Ulsan, 44033, Republic of Korea.

There are conflicting hypotheses regarding the initial pathogenesis of carpal tunnel syndrome (CTS). One hypothesis characterizes it as inflammation of the median nerve caused by compression, while another hypothesis characterizes CTS as non-inflammatory fibrosis of the subsynovial connective tissue (SSCT). This study aimed to investigate the differences in the ultrasonography parameters before and after a steroid injection, which is effective for CTS, to elucidate the initial pathogenesis of CTS and the mechanisms of action of the injected steroid. Read More

Hand (N Y) 2020 Aug 6:1558944720944263. Epub 2020 Aug 6.

Hospital Universitario Ramón y Cajal, Madrid, Spain.

In a previous paper, we have demonstrated that: (1) local injection of corticosteroids for carpal tunnel syndrome (CTS) is as effective as decompressive surgery, at 1-year follow-up; and (2) surgery has an additional benefit in the 2-year follow-up. In this study, we assess the long-term outcomes of both therapies in an observational extension of the patients originally enrolled in our randomized clinical trial. Patients were included in an open, randomized clinical trial, comparing injections versus surgery in CTS. Read More

Clin Rheumatol 2021 Mar 21;40(3):1069-1076. Epub 2020 Jul 21.

Department of Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India.

Objectives: (1) Development and validation of a composite ultrasound score (cUSS) for the diagnosis of carpal tunnel syndrome (CTS). (2) To predict treatment response after local corticosteroid injection.

Methods: Wrists of CTS patients and controls were evaluated with high-resolution ultrasound and cross-sectional area of median nerve at carpal tunnel inlet (CSAp) and outlet (CSAd) and bowing of flexor retinaculum (FRB), flexor tenosynovitis, and intraneural vascularity and echogenicity changes were noted. Read More

Arch Phys Med Rehabil 2020 11 16;101(11):1857-1864. Epub 2020 Jul 16.

Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, National Yang Ming University, Taipei, Taiwan. Electronic address:

Objectives: To evaluate whether the therapeutic effect of ultrasound-guided injections with 10 mg or 40 mg triamcinolone acetonide (TA) was dose-dependent in patients with idiopathic mild to moderate carpal tunnel syndrome (CTS).

Design: Prospective, double-blind, randomized controlled study with 12 weeks of follow-up.

Setting: Rehabilitation outpatient clinic of a single medical center. Read More

World Neurosurg 2020 07 27;139:548. Epub 2020 Apr 27.

Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA. Electronic address:

Carpal tunnel syndrome represents compression of the median nerve in the carpal tunnel, which is defined by the carpal bones on the lateral, medial, and dorsal aspects and the transverse carpal ligament on the anterior aspect. Symptoms of carpal tunnel syndrome include paresthesia, anesthesia, paresis, and pain located in the median nerve distribution. In severe cases, there may be atrophy of median nerve-innervated thenar muscles. Read More

J Hand Surg Am 2020 Aug 25;45(8):690-697.e7. Epub 2020 Apr 25.

Purpose: To evaluate, from the surgeon's perspective, the importance, feasibility, and appropriateness of sharing decisions during an episode of care of carpal tunnel syndrome (CTS) or distal radius fracture in patients aged greater than 65 years.

Methods: A consortium of 9 fellowship-trained hand/upper-limb surgeons used the RAND Corporation/University of California Los Angeles Delphi Appropriateness method to evaluate the importance, feasibility, and appropriateness of sharing 27 decisions for CTS and 28 decisions for distal radius fractures in patients aged greater than 65 years. Panelists rated each measure on a scale of 1 (definitely not important/feasible/appropriate) to 9 (definitely important/feasible/appropriate) in 2 voting rounds with an intervening face-to-face discussion. Read More

Ann Plast Surg 2020 08;85(2):127-134

From the Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea.

Purpose: The main cause of carpal tunnel syndrome (CTS) is pathological changes in the flexor synovium, which is a known cause of pressure elevation in the carpal tunnel. The importance of the transverse carpal ligament (TCL) in the pathogenesis of CTS has hitherto been overlooked. However, the TCL significantly affects carpal biomechanics; the TCL is known to affect the carpal bone to a greater extent when intra carpal tunnel pressure is high. Read More

J Pharmacopuncture 2020 Mar;23(1):37-41

Department of Acupuncture & Moxibustion medicine, College of Korean medicine, Daegu Haany University, Republic of Korea.

Objectives: Round Acupuncture having blunt end has developed from acupotomy. This case report is to find out that Round Acupuncture is effective in treating patients with recurrent carpal tunnel syndrome (CTS), which has not improved by steroid injection or acupotomy.

Methods: Round Acupuncture was inserted into the distal fibers of transverse carpal ligament and released toward the proximal fibers. Read More

Muscle Nerve 2020 07 23;62(1):89-94. Epub 2020 Apr 23.

Department of Medical Biometrics and Informatics, Jawaharlal Institute of Postgraduate Medical Education, Pondicherry, India.

Introduction: Evidence for the efficacy of distal corticosteroid injection compared with proximal injection in carpal tunnel syndrome (CTS) is inadequate.

Methods: We conducted a randomized, double-blind noninferiority trial of 131 wrists with CTS. Forty milligrams of methylprednisolone was injected medial to the palmaris longus tendon 2 cm proximal to the wrist crease, or at the volar aspect, 2 to 3 cm distal to the wrist crease. Read More

Pharmaceuticals (Basel) 2020 Mar 18;13(3). Epub 2020 Mar 18.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara 06100, Turkey.

This network meta-analysis aimed to integrate the available direct and indirect evidence on regenerative injections-including 5% dextrose (D5W) and platelet-rich plasma (PRP)-for the treatment of carpal tunnel syndrome (CTS). Literature reports comparing D5W and PRP injections with non-surgical managements of CTS were systematically reviewed. The main outcome was the standardized mean difference (SMD) of the symptom severity and functional status scales of the Boston Carpal Tunnel Syndrome Questionnaire at three months after injections. Read More

Ann Dermatol Venereol 2020 Apr 11;147(4):316-317. Epub 2020 Mar 11.

Service de dermatologie et allergologie, faculté de médecine, Sorbonne université, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.

Obstet Gynecol Surv 2020 Feb;75(2):121-126

Associate Professor, Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR.

Importance: Carpal tunnel syndrome and meralgia paresthetica are 2 common neuropathies complicating pregnancy. Each of these causes significant discomfort but can be diagnosed and treated safely during pregnancy.

Objective: This article outlines the existing literature diagnosis, treatment, and prognosis of carpal tunnel syndrome and meralgia paresthetica, specifically looking at the implications during pregnancy. Read More