Investigation and comparison of the efficacy of ultrasound-guided median nerve hydrodissection with dexamethasone and dextrose in patients with carpal tunnel syndrome

Aim: To compare the clinical, electrophysiological and ultrasonographic effects of 5% dextrose and dexamethasone at different volumes in ultrasound-guided hydrodissection for the treatment of carpal tunnel syndrome. Method: 88 patients with clinically diagnosed CTS, and mild to moderate CTS based on electrophysiological evaluation, were included in the study. The patients were divided into four groups through block randomization. Group 1 received 5 ml of 5% dextrose, group 2 received 10 ml of 5% dextrose, group 3 received 2 ml of dexamethasone+ 3 ml of normal saline, and group 4 received 2 ml of dexamethasone+ 8 ml of normal saline. All administered with ultrasound guidance. The patients were evaluated using pain, symptom, and functionality scores, and ultrasonography before injection and at 2, 4, and 12 weeks after injection. Evaluation using electrophysiological studies conducted before injection and 12 weeks after injection. Results: Numeric rating scale scores significantly improved in all groups (p<0.01). Significant improvement was observed in all groups except for the Boston Carpal Tunnel Questionnaire- Symptom Severity Score (BCTQ-SSS) and Quick-Disabilities of Arm, Shoulder and Hand Questionnaire (Q-DASH) in group 2, BCTQ- Functional Status Score (FSS) and CTS-6 scores in groups 2 and 3 at week 12 (p<0.05). Only group 1 showed significant improvement in the cross-sectional area of the median nerve (p<0.05). Sensory nerve conduction velocity, distal sensory latency significantly improved in all groups (p<0.05). Significant improvement was observed in all groups except sensory nerve action potential in group 4 and distal motor latency in group 2 (p<0.05). Conclusion: Clinical, ultrasonographic, and electrophysiological parameters improved significantly with 5% dextrose and dexamethasone (5 or 10 ml) during the 3 month follow-up. No significant difference was observed between the groups.