Hydrodissection in Carpal Tunnel Syndrome (KTS)

Ankara City Hospital

Status: Completed

Conditions: Median Nerve Entrapment; Carpal Tunnel Syndrome

Treatments: Procedure: Comparison of three different injection techniques using hydrodissection with 5% dextrose in the treatment of CTS

Study type: Interventional

Funder types: Other

Identifiers

NCT07207460

E2-23-4769

Details and patient eligibility

About

The aim of this study was to compare the effectiveness of perineural hydrodissection methods performed with 5 mL D5W solution and three different injection techniques [ultrasound-guided in-plane, ultrasound-guided out-of-plane, and blind technique] in cases diagnosed with mild to moderate CTS by EMG.

Full description

Carpal tunnel syndrome (CTS) is a highly prevalent condition in the general population, markedly impairing daily activities and sleep quality. Depending on disease severity and symptom burden, treatment approaches are broadly categorized as conservative or surgical. Beyond lifestyle modifications, numerous conservative interventions-including splinting, extracorporeal shock wave therapy, therapeutic ultrasound, phonophoresis, hydrodissection, kinesiotaping, corticosteroid (CS) injections, low-level laser therapy, platelet-rich plasma (PRP) injections, manual therapy, and acupuncture-have demonstrated clinical efficacy. More recently, 5% dextrose injections have emerged as a safe alternative to CS with minimal adverse effects. Injection therapies vary in both content and technique; however, no consensus exists regarding the optimal approach. Given the importance of minimizing side effects and ensuring long-term effectiveness, the refinement of injection agents and techniques remains a priority. Although ultrasound-guided injections improve safety and accuracy, they require expertise and incur additional costs, whereas blind techniques have long been applied reliably in clinical practice. Nevertheless, comparative studies evaluating these techniques remain limited. Therefore, the present study aimed to compare three different injection techniques for the management of CTS.

Enrollment: 74 patients

Sex: All

Ages: 20 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients between the ages of 20-70
• Moderate and mild CTS patients diagnosed with CTS by EMG
• Literate patients who agreed to participate in the study

Exclusion criteria

• Patients with RA, type 1 or type 2 diabetes mellitus
• Patients with chronic renal failure
• Polyneuropathy
• Those with a history of cancer, those receiving chemotherapy
• Those with a history of broken hand wrist fracture in the last 6 months
• Patients with brachial plexopathy or thoracic outlet syndrome (TOS)
• Patients who underwent surgery due to CTS
• Pregnancy
• Hypothyroidism in a mixed edema picture
• Diagnosed with neuromuscular disease
• Patients with bleeding disorders or those currently receiving anticoagulant therapy
• patients with infection at the injection site

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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74 participants in 3 patient groups

ultrasound-guided in-plane injection technique

Active Comparator group

Description:

With the patient seated, the lower third of the forearm and the entire palm were sterilized using 2% povidone-iodine. A sterile cover was applied to the ultrasound probe, and sterile gel was placed on the skin. The probe was positioned transversely at the palmar wrist crease at the entrance of the carpal tunnel, allowing visualization of the pisiform, ulnar nerve, and ulnar artery . The ulnar nerve lies just radial to the pisiform, with the ulnar artery located radial to the ulnar nerve; Doppler imaging was used when necessary to confirm arterial position. After identifying the median nerve with ultrasound, a 22-gauge, 38 mm needle was advanced via the ulnar approach. The ulnar nerve and artery were visualized throughout the procedure. The needle was first advanced to the inferior surface of the median nerve with the bevel facing upward; following negative aspiration, 2.5 mL of 5% dextrose solution was injected. Without removing the needle from the skin, the bevel was then r

Treatment:

Procedure: Comparison of three different injection techniques using hydrodissection with 5% dextrose in the treatment of CTS

ultrasound-guided out-of-plane injection technique

Active Comparator group

Description:

The patient was seated, and the lower third of the forearm and the entire palm were sterilized with 2% povidone-iodine. A sterile drape covered the ultrasound probe, and sterile gel was applied to the skin. The probe was placed transversely at the proximal wrist crease to visualize the median nerve, then shifted ulnarly to identify the pisiform, ulnar nerve, and ulnar artery. Doppler imaging was used when necessary to confirm arterial position. For the out-of-plane technique, a proximal-to-distal longitudinal approach was employed. With the median nerve visualized, a 22-gauge, 38 mm needle was inserted, and after negative aspiration, 5 mL of 5% dextrose solution was injected between the median nerve and the flexor retinaculum

Treatment:

Procedure: Comparison of three different injection techniques using hydrodissection with 5% dextrose in the treatment of CTS

blind technique

Active Comparator group

Description:

This injection technique relies on anatomical landmarks, targeting the space between the palmaris longus tendon and the flexor carpi radialis. The patient was seated, and the lower third of the forearm and the entire palm were sterilized using 2% povidone-iodine. The most commonly used landmarks for the blind approach were the ulnar edge of the palmaris longus tendon and the proximal wrist crease. A 22-gauge, 38 mm needle was inserted at the ulnar border of the palmaris longus tendon along the scaphoid-pisiform line and advanced distally toward the ring finger at an angle of approximately 30°-45°. In patients lacking a palmaris longus tendon, the needle was inserted just ulnar to the wrist midline. Upon patient-reported paresthesia, the needle was slightly withdrawn and redirected ulnarly. Aspiration was performed in all cases to avoid intravascular injection, and 5 mL of 5% dextrose solution was administered slowly and steadily.

Treatment:

Procedure: Comparison of three different injection techniques using hydrodissection with 5% dextrose in the treatment of CTS