Effect of Perineural Injection with Different Dextrose Volumes on Median Nerve Size, Elasticity and Mobility in Hands with Carpal Tunnel Syndrome

Meng-Ting Lin, I-Chun Liu, Wei-Ting Syu, Po-Ling Kuo, Chueh-Hung Wu, Meng-Ting Lin, I-Chun Liu, Wei-Ting Syu, Po-Ling Kuo, Chueh-Hung Wu

Abstract

This study aimed to investigate the effect of different injectate volumes on ultrasonographic parameters and the correlation to clinical outcomes under perineural dextrose injection (PDI). In this post hoc analysis of the randomized, double-blinded, three-arm trial, ultrasound-guided PDI with either 1 mL, 2 mL, and 4 mL 5% dextrose water was administered, respectively, in 14, 14, and 17 patients. Ultrasound outcomes included mobility, shear-wave elastography (SWE), and cross-sectional area (CSA) of the median nerve; clinical outcomes were Visual Analog Scale (VAS) and Boston Carpal Tunnel Questionnaire (BCTQ) score. Outcomes were measured before injection, and after injection at the 1st, 4th, 12th, and 24th week. For ultrasound outcomes, CSA decreased significantly from baseline data at all follow-up time-points in the 2 mL group (p = 0.005) and the 4 mL group (p = 0.015). The mean change of mobility from baseline showed a greater improvement on the 4 mL group than the other groups at the 1st week post-injection. For clinical outcomes, negative correlation between the VAS and mobility at the 1st (p = 0.046) and 4th week (p = 0.031) post-injection in the 4 mL group were observed. In conclusion, PDI with higher volume yielded better nerve mobility and decreased CSA of median nerve, but no changes of nerve elasticity.

Keywords: elasticity imaging techniques; median nerve; nerve compression syndromes.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Measurement of ultrasound outcomes with (A) cross-section area (CSA), (B) shear-wave elastography (SWE), and (C) centroid position of the median nerve. (A) CSA of median nerve is measured at the carpal tunnel inlet level between scaphoid bone (S) and pisiform bone (P). (B) SWE of median nerve is measured at the carpal tunnel inlet level. Red color implies stiffer tissue and blue color implies soft tissue. Circular region is for quantitation of tissue stiffness in kilopascals (kPa) units. (C) Distance of the centroid position of the median nerve between the finger extension and full flexion position is recorded on ultrasound video. P = Pisiform bone. S = Scaphoid bone. N = Median nerve.

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