Article

Corticosteroid injection into the carpal tunnel is frequently used
for the treatment of carpal tunnel syndrome (CTS). Steroids are usually mixed
with local anesthetics, which have positive effects that can aid the treatment of
CTS by inhibiting the spontaneous discharge ability of excitable cells. The aim
of this study was 3-fold: (1) to determine the efficacy of triamcinolone
acetonide injection in the treatment of CTS, (2) to determine the efficacy of
procaine hydrochloride (HCl) in the treatment of CTS, and (3) to compare the
efficacy of triamcinolone acetonide and that of procaine HCl in the treatment of
CTS. DESIGN: : This prospective, randomized, double-blind clinical trial included
99 patients (120 median nerves) with clinical and electrophysiologic evidence of
CTS. The 120 median nerves were randomly assigned to one of three groups: group 1
received 40 mg of triamcinolone acetonide, group 2 received 4 ml of 1% procaine
HCl, and group 3 received both 40 mg of triamcinolone acetonide and 4 ml of 1%
procaine HCl. Clinical and electrophysiologic evaluations were performed at the
study onset and at 2 and 6 mos after treatment. RESULTS: : At the study onset,
there were no statistically significant differences between the groups with
respect to distal motor latency, compound motor action potential, compound
sensory action potential, sensory nerve conduction velocity, or visual analog
scale score; however, distal motor latency, compound sensory action potential
amplitude, sensory nerve conduction velocity, and visual analog scale scores
improved significantly in each group 2 mos after treatment (P < 0.05), and these
improvements persisted at 6 mos after treatment (P < 0.05). Significant
differences were not observed between groups 1 and 2 or between groups 1 and 3
with respect to electrophysiologic findings at baseline or 2 or 6 mos after
treatment (P > 0.05). Group 3 had better compound sensory action potential
amplitude and sensory nerve conduction velocity scores than group 2 did at 6 mos
(P < 0.05) and better visual analog scale scores than group 2 did at 2 and 6 mos
(P < 0.05). CONCLUSIONS: : Local procaine HCl injection and steroid injection
effectively reduced the symptoms of CTS and equally improved electrophysiologic
findings. As such, procaine HCl can be used in CTS patients in whom steroid use
is contraindicated.

Langue : ANGLAIS