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Six-month Efficacy of Perineural Dextrose for Carpal Tunnel Syndrome

A Prospective, Randomized, Double-Blind, Controlled Trial
  • Yung-Tsan Wu
    Affiliations
    Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, Taipei, Taiwan, Republic of China

    Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, Taipei, Taiwan, Republic of China
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  • Tsung-Yen Ho
    Affiliations
    Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, Taipei, Taiwan, Republic of China
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  • Yu-Ching Chou
    Affiliations
    School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China
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  • Ming-Jen Ke
    Affiliations
    Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, Taipei, Taiwan, Republic of China
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  • Tsung-Ying Li
    Affiliations
    Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, Taipei, Taiwan, Republic of China

    Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, Taipei, Taiwan, Republic of China
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  • Chia-Kuang Tsai
    Affiliations
    Department of Neurology, Tri-Service General Hospital, School of Medicine, Taipei, Taiwan, Republic of China

    Graduate Institute of Medical Science, School of Medicine, Taipei, Taiwan, Republic of China
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  • Liang-Cheng Chen
    Correspondence
    Correspondence: Address to Liang-Cheng Chen, MD, Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No 325, Sec 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China.
    Affiliations
    Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, Taipei, Taiwan, Republic of China
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      Abstract

      Objective

      To assess the 6-month effectiveness of ultrasound-guided perineural injection therapy (PIT) using 5% dextrose (D5W) in patients with mild-to-moderate carpal tunnel syndrome (CTS).

      Patients and Methods

      A prospective, randomized, placebo-controlled, and double-blind study was conducted between May 1, 2016, through March 30, 2017. A total of 49 participants diagnosed with mild-to-moderate CTS were randomized into D5W and control groups. Participants in the D5W group received 1 session of ultrasound-guided PIT with 5 cc of D5W, and the control group received PIT with normal saline. The visual analog scale measured pain as a primary outcome. Secondary outcomes were Boston Carpal Tunnel Syndrome Questionnaire scores, the cross-sectional area of the median nerve, and electrophysiological measurement results. Assessment was performed before injection and at 1, 3, and 6 months post-injection.

      Results

      All patients (data from 30 wrists in each group) completed the study. Compared with the control group, at all post-injection time points, the D5W group had a significant reduction in pain and disability, improvement on electrophysiological response measures, and decreased cross-sectional area of the median nerve.

      Conclusion

      Our study reveals that ultrasound-guided PIT with D5W is an effective treatment for patients with mild-to-moderate CTS.

      Trial Registration

      Abbreviations and Acronyms:

      BCTQ (Boston Carpal Tunnel Syndrome Questionnaire), CSA (cross-sectional area), CTS (carpal tunnel syndrome), D5W (5% dextrose), DML (distal motor latency), MN (median nerve), PIT (perineural injection therapy), SNCV (sensory nerve conduction velocity), VAS (visual analog scale)
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