Carpal tunnel syndrome (CTS) is a common peripheral nerve entrapment disorder caused by compression of the median nerve at the wrist. This study is a comparative study designed to evaluate the efficacy of three ultrasound-guided injection treatments for patients with mild to moderate CTS: hyaluronic acid (HA), corticosteroid, and 5% glucose (D5W).
A total of 60 adult patients with clinically and electrophysiologically confirmed mild to moderate CTS will be enrolled and divided into three groups of 20 patients each. Participants will receive a single ultrasound-guided injection using one of the three study interventions. Clinical assessment will include Phalen's test and Tinel's sign. Electrophysiological assessment will include median nerve sensory and motor nerve conduction parameters, while ultrasonographic assessment will include measurement of the median nerve cross-sectional area.
Participants will be reassessed three months after the intervention using the same clinical, electrophysiological, and ultrasonographic measures. The study will compare changes in these outcomes among the three treatment groups to evaluate their relative efficacy in the management of mild to moderate CTS.
None
Prior injection into the same wrist within the previous 6 months. Previous carpal tunnel surgery. Severe carpal tunnel syndrome, defined by absent sensory potentials or electromyographic evidence of denervation.
Parallel
Hyaluronic Acid- corticosteroid- 5% glucose
DrugAll injections will be performed under sterile conditions with ultrasound guidance. The participant will be positioned either supine or seated with the forearm supinated. The ultrasound probe will be positioned transversely over the inlet of the carpal tunnel, and an in-plane ulnar approach will be used. Particular care will be taken to avoid piercing the median nerve. Participants will receive one of the following ultrasound-guided injection interventions: Group 1 - Hyaluronic Acid Participants in the HA group will receive 2-3 mL of high-molecular-weight hyaluronic acid. The HA will be injected perineurally with the intention of creating a gliding plane around the median nerve and reducing perineural adhesions. Group 2 - Corticosteroid Participants in the corticosteroid group will receive triamcinolone acetonide 40 mg mixed with 1 mL of lidocaine.
Change in median nerve cross-sectional area (CSA)
Median nerve cross-sectional area measured by ultrasound at baseline and 3 months after treatment, comparing the change among the three treatment groups.
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