Different doses of steroid injection in elderly patients with carpal tunnel syndrome: a triple-blind, randomized, controlled trial

Reza Salman Roghani,1,2 Mohammad Taghi Holisaz,3 Masoud Tarkashvand,3 Ahmad Delbari,4 Faeze Gohari,2 Andrea J Boon,5,6 Johan Lokk1 1Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden; 2Physical Medicine and Rehabilitation...

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Autores principales:	Salman Roghani R, Holisaz MT, Tarkashvand M, Delbari A, Gohari F, Boon AJ, Lokk J
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	Elderly Carpal Tunnel Syndrome Steroid injection Ultrasonography Hydrodissection Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/9c9fadd7d8294608bbdd19fd5212b81b
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spelling	oai:doaj.org-article:9c9fadd7d8294608bbdd19fd5212b81b2021-12-02T02:29:33ZDifferent doses of steroid injection in elderly patients with carpal tunnel syndrome: a triple-blind, randomized, controlled trial1178-1998https://doaj.org/article/9c9fadd7d8294608bbdd19fd5212b81b2018-01-01T00:00:00Zhttps://www.dovepress.com/different-doses-of-steroid-injection-in-elderly-patients-with-carpal-t-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Reza Salman Roghani,1,2 Mohammad Taghi Holisaz,3 Masoud Tarkashvand,3 Ahmad Delbari,4 Faeze Gohari,2 Andrea J Boon,5,6 Johan Lokk1 1Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden; 2Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, 3Department of Physical Medicine and Rehabilitation, Baqiyatallah University of Medical Sciences, 4Research Center on Aging, University of Social Welfare and Rehabilitation, Tehran, Iran; 5Department of Physical Medicine and Rehabilitation, 6Department of Neurology, Mayo Clinic, Rochester, MN, USA Background: Carpal tunnel syndrome (CTS) is commonly seen in elderly populations, in part due to increased presence of predisposing comorbidities as well as physiological changes. We aimed at comparing the effectiveness of different doses of steroid using the ultrasound-guided hydrodissection method in elderly patients with CTS.Methods: We conducted a prospective, triple-blind, randomized, controlled trial in elderly patients with CTS. Patients were allocated to one of three groups by simplified randomization. Groups I–III received 80 mg triamcinolone (2 mL) and 1 mL of 2% lidocaine; 40 mg triamcinolone (1 mL), 1 mL of 2% lidocaine, and 1 mL normal saline; and 1 mL of 2% lidocaine and 2 mL normal saline, respectively to make up to 3 mL volume. A wrist splint was then applied for support. Outcome measures included the visual analog scale (VAS) and the Boston Carpal Tunnel Questionnaire, and median motor and sensory nerve conduction and its sonographic inlet cross-sectional area were used as objective measures. All data were recorded at baseline and 2, 12, and 24 weeks after injection. The investigators, patients, and statistician were blinded to the treatment assignment.Results: In total, 161 patients were recruited without statistically significant demographic differences between the three groups. There were no statistically significant differences between groups in any outcome, with the exception of the median distal motor latency, which was greater in Group II at all three follow-up visits, and significant baseline VAS difference between Groups I and III.Conclusion: Hydrodissection with lidocaine and normal saline is as effective as hydrodissection with low- and high-dose steroid medication in elderly patients with CTS in this study, but further studies with matched baseline measures and also a sham group are suggested for definitive recommendation. Keywords: elderly, carpal tunnel syndrome, steroid injection, ultrasonography, hydrodissection, hand pain, paresthesiaSalman Roghani RHolisaz MTTarkashvand MDelbari AGohari FBoon AJLokk JDove Medical PressarticleElderlyCarpal Tunnel SyndromeSteroid injectionUltrasonographyHydrodissectionGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 13, Pp 117-124 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Elderly Carpal Tunnel Syndrome Steroid injection Ultrasonography Hydrodissection Geriatrics RC952-954.6
spellingShingle	Elderly Carpal Tunnel Syndrome Steroid injection Ultrasonography Hydrodissection Geriatrics RC952-954.6 Salman Roghani R Holisaz MT Tarkashvand M Delbari A Gohari F Boon AJ Lokk J Different doses of steroid injection in elderly patients with carpal tunnel syndrome: a triple-blind, randomized, controlled trial
description	Reza Salman Roghani,1,2 Mohammad Taghi Holisaz,3 Masoud Tarkashvand,3 Ahmad Delbari,4 Faeze Gohari,2 Andrea J Boon,5,6 Johan Lokk1 1Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden; 2Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, 3Department of Physical Medicine and Rehabilitation, Baqiyatallah University of Medical Sciences, 4Research Center on Aging, University of Social Welfare and Rehabilitation, Tehran, Iran; 5Department of Physical Medicine and Rehabilitation, 6Department of Neurology, Mayo Clinic, Rochester, MN, USA Background: Carpal tunnel syndrome (CTS) is commonly seen in elderly populations, in part due to increased presence of predisposing comorbidities as well as physiological changes. We aimed at comparing the effectiveness of different doses of steroid using the ultrasound-guided hydrodissection method in elderly patients with CTS.Methods: We conducted a prospective, triple-blind, randomized, controlled trial in elderly patients with CTS. Patients were allocated to one of three groups by simplified randomization. Groups I–III received 80 mg triamcinolone (2 mL) and 1 mL of 2% lidocaine; 40 mg triamcinolone (1 mL), 1 mL of 2% lidocaine, and 1 mL normal saline; and 1 mL of 2% lidocaine and 2 mL normal saline, respectively to make up to 3 mL volume. A wrist splint was then applied for support. Outcome measures included the visual analog scale (VAS) and the Boston Carpal Tunnel Questionnaire, and median motor and sensory nerve conduction and its sonographic inlet cross-sectional area were used as objective measures. All data were recorded at baseline and 2, 12, and 24 weeks after injection. The investigators, patients, and statistician were blinded to the treatment assignment.Results: In total, 161 patients were recruited without statistically significant demographic differences between the three groups. There were no statistically significant differences between groups in any outcome, with the exception of the median distal motor latency, which was greater in Group II at all three follow-up visits, and significant baseline VAS difference between Groups I and III.Conclusion: Hydrodissection with lidocaine and normal saline is as effective as hydrodissection with low- and high-dose steroid medication in elderly patients with CTS in this study, but further studies with matched baseline measures and also a sham group are suggested for definitive recommendation. Keywords: elderly, carpal tunnel syndrome, steroid injection, ultrasonography, hydrodissection, hand pain, paresthesia
format	article
author	Salman Roghani R Holisaz MT Tarkashvand M Delbari A Gohari F Boon AJ Lokk J
author_facet	Salman Roghani R Holisaz MT Tarkashvand M Delbari A Gohari F Boon AJ Lokk J
author_sort	Salman Roghani R
title	Different doses of steroid injection in elderly patients with carpal tunnel syndrome: a triple-blind, randomized, controlled trial
title_short	Different doses of steroid injection in elderly patients with carpal tunnel syndrome: a triple-blind, randomized, controlled trial
title_full	Different doses of steroid injection in elderly patients with carpal tunnel syndrome: a triple-blind, randomized, controlled trial
title_fullStr	Different doses of steroid injection in elderly patients with carpal tunnel syndrome: a triple-blind, randomized, controlled trial
title_full_unstemmed	Different doses of steroid injection in elderly patients with carpal tunnel syndrome: a triple-blind, randomized, controlled trial
title_sort	different doses of steroid injection in elderly patients with carpal tunnel syndrome: a triple-blind, randomized, controlled trial
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/9c9fadd7d8294608bbdd19fd5212b81b
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Different doses of steroid injection in elderly patients with carpal tunnel syndrome: a triple-blind, randomized, controlled trial

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