Various median nerve anatomical variations have been reported in the literature.One of these is the bifid median nerve.Due to its relatively higher cross-sectional area, it can facilitate compression of the median nerve in the carpal tunnel.Therefore, bifid median nerve is relatively common in patients with CTS.Some studies have shown that the bifid median nerve has an effect on surgical failure in the treatment of carpal tunnel syndrome.Apart from surgical treatment, perineural injection with corticosteroids is a treatment method that has been used for a long time in the treatment of mild and moderate carpal tunnel syndrome.It is controversial whether bifid median nerve has a negative effect on treatment effectiveness.When looking at the literature, there is no previous study on this subject.With the introduction of ultrasound into our daily practice, the frequency of ultrasound-guided perineural injections has increased.Ultrasound allowed us to see variations in the median nerve before injection.The aim of the study is to compare the effectiveness of steroid injection in patients with CTS with bifid median nerve and patients with CTS with non-variant median nerve.It is also to investigate whether this anatomical variation has a negative effect on the treatment.
Being between the ages of 18-65
Being clinically diagnosed with Carpal Tunnel Syndrome
Confirmation of mild and moderate Carpal Tunnel Syndrome diagnosis with EMG
Diagnosis of bifid median nerve after ultrasound evaluation, No variation was detected for the control group either.
History of polyneuropathy, brachial plexopathy, thoracic outlet syndrome, or wrist surgery
History of Inflammatory arthritis, hypothyroidism, pregnancy,rheumatological disorders or heart battery
current warfarin use, Prior steroid injection for CTS, trauma or neoplasm at the injection site, hypersensitivity to corticosteroids or skin infection at the injection site
other median nerve variations and presence of persistent median artery.
Parallel
2 cc:(1 cc betamethasone dipropionate+1cc physiological saline)
DrugEach patient will receive 2 cc:(1 cc betamethasone dipropionate+1cc physiological saline) perineural injection into the median nerve under US guidance, for 1 session.
Visual Analog Scale(VAS)
Global pain:The VAS used for pain assessment consists of a line drawn in the form a ruler,and numbers from 0 to 10(with 0 as ''no pain'' and 10 as ''unbearable pain'' ) were asked to score.
Boston Carpal Tunnel Questionnaire
symptom severity and functional status scale
Electromyography
Distal motor latency and sensory nerve conduction velocity
Dynamometer
Hand grip strength measurement test
Ultrasound
Median nerve cross-sectional area measurement at the pisiform level
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Yunus Burak Bayır
Lead sponsor
Ankara Etlik City Hospital
Sponsor institution
