Disclosures: Aashna Basu, MD: Nothing to disclose

Objective: To assess the clinical response of two different steroid doses, 20 mg vs. 40 mg triamcinolone acetonide (Kenalog), injected under ultrasound (US) guidance with the ulnar in-plane approach for mild to severe carpal tunnel syndrome (CTS).

Design: Prospective, single-blinded, randomized study.

Setting: Veterans Affairs Hospital.

Participants: PM&R outpatient clinic patients were eligible if symptomatic with electrodiagnostically confirmed CTS.

Interventions: Group 1 received 20 mg Kenalog + 1.5 mL 1% lidocaine and Group 2 received 40 mg Kenalog + 1.0 mL 1% lidocaine injected into the carpal tunnel.

Main Outcome Measures: 1) Boston Carpal Tunnel Questionnaire (BCTQ) and 2) Ultrasound Median nerve wrist-to-forearm ratio (WFR) measurements were used at baseline and 1-month follow-up.

Results: 42 subjects were randomized between Group 1 (n=19) and Group 2 (n=23). Average pre- and post-corticosteroid injection (CSI) BCTQ scores and WFR measurements were compared between groups using repeated measures analysis of variance (rmANOVA). There was no statistically significant difference between dose groups for BCTQ scores. Comparison of BCTQ within each group at baseline and 1-month follow-up using paired t-tests revealed statistically significant improvement in symptom severity [SSS 20 mg Δ=0.86 (P<.001); SSS 40 mg Δ=1.29 (P<.001)] and functional deficits [FSS 20 mg Δ=0. 58 (P=.016); FSS 40 mg Δ=0.84 (P<.001)]. The WFR measurements improved with both doses, but only the 40 mg group reached statistical significance (P=.002). Review of mild-moderate versus severe CTS response to both steroid doses is in progress.

Conclusions: This study suggests that both the 20 mg and 40 mg steroid injections using the US guided ulnar in-plane approach are comparably efficacious in reducing symptom severity and functional deficits to a clinically meaningful degree. In addition, it will be useful to determine whether the severity of CTS diagnosis plays a role in the dose response. Notably, all wrists injected in this study improved in subjective and objective outcome measures without any adverse effects.

Level of Evidence: Level I

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/response-to-ultrasound-guided-median-nerve-injections-for-carpal-tunnel-syndrome-based-on-dose-and-severity/