Carpal Tunnel – D5W Perineural Injection Under Ultrasound Beats Steroid Injection

Injecting 5 mls  D5W under Ultrasound control resulted in equal results of D5W vs triamcinolone 30 mg for first 3 months – then D5W better.

Ann Neurol. 2018 Sep 5. doi: 10.1002/ana.25332. [Epub ahead of print]
Randomized double-blinded clinical trial of 5% dextrose versus triamcinolone
injection for carpal tunnel syndrome patients.
Wu YT
https://www.ncbi.nlm.nih.gov/pubmed/30187524

  • 27 cases in each group
  • Injection procedure: “The MN [median nerve] was identified at the proximal inlet of the carpal tunnel (scaphoid-pisiform plane). Under in-plane ulnar approach, 3 cc injectate was injected to hydrodissect the MN from the flexor retinaculum, and the residual 2 cc injectate was then injected to hydrodissect the inferior MN away from the flexor tendons.  After injection, the operator scanned through the whole carpal tunnel to confirm the delivery of injectate throughout the tunnel “
  • 30 mg triamcinolone was injected for steroid group same way.

results:

carpal_tunnel_D5W

Comment – for best results would need US, though could try D5W using a nerve probe so not get too close to nerve. Would think repeat injection of D5W would have better results.

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