Submitted by: Clark W. Pinyan, MD, MPH
Edited by: Niranjan N. Singh, MD
Wu YT, Ke MJ, Ho TY, et al. Randomized double-blinded clinical trial of 5% dextrose versus triamcinolone injection for carpal tunnel syndrome patients. Annals of Neurology
In this study, the authors compared injection of 5cc D5W (dextrose group, 27 wrists) to 3ml triamcinolone in 2cc NS (steroid group, 27 wrists) under ultrasound guidance in patients with mild to moderate carpal tunnel syndrome. Both groups showed improvement in both the visual analog scale of symptoms and the Boston Carpal Tunnel Questionnaire in the first 3 months. Improvement in the steroid group reversed through the 3rd to the 6th month, with continued improvement in the dextrose group. Significant difference between the 2 groups was seen at the 4th and 6th months. Electrophysiologic measures were also compared. Ultrasonographic median nerve cross sectional area decreased in both groups over 6 months, and sensory nerve conduction velocity decreased in the dextrose group. Overall, however, there were no noteworthy differences between electrophysiological findings in the steroid and dextrose groups. The authors conclude that a single perineural D5W injection leads to significant reduction in pain and disability compared to the corticosteroid, from the 4th month post injection, and given the side effects of steroids, deem it to be a “better choice.”
This is a small but prospective double-blind randomized trial comparing the efficacy of ultrasound-guided steroid versus dextrose injection in mild to moderate carpal tunnel syndrome. Steroid injections have been used for decades in mild to moderate carpal tunnel syndrome – major drawbacks being short-term benefit and neurotoxicity. Dextrose injections are emerging as a novel therapy with longer duration of benefit in mild to moderate carpal tunnel syndrome.