Comparison of injection methods and surgical treatment in carpal tunnel syndrome

Aim: Carpal tunnel syndrome is the most common peripheral neuropathy. It is manifested by numbness in the hands, tingling and loss of strength in the later period. Diagnosis is made by anamnesis, clinical examination, electrophysiological and radiological evaluation. Conservative and surgical methods can be used in treatment. The aim of this study is to compare surgery, steroid and PRP injection therapy in mild and moderate KTS; to evaluate their clinical, electrophysiological and ultrasonographic superiority over each other. Materials and methods: 92 wrists of 68 patients with mild and moderate KTS were included in the study. After the patients were randomized, surgical treatment was given to the 1st group, steroid injections were administered to the 2nd group under the guidance of ultrasonography (USG), and PRP injection was administered to the 3rd group under the guidance of USG. The patients were evaluated before the treatment and at the 1st, 3rd and 6th months after the treatment. Phalen and tinel tests were examined in the physical examinations of the patients. The severity of pain and numbness of the patients was evaluated with the visual analog scale (VAS), and the functional status and severity of the symptoms were evaluated with the Boston carpal tunnel questionnaire. In addition, nerve conduction studies were performed on the patients; The cross-sectional area (MSKA) and flattening ratio (YO) of the median nerve were calculated by USG. Results: In the 3rd month of surgical treatment, the phalen tests of all patients became negative. In all three groups, the decrease in VAS and Boston symptom severity was significant at the 1st month control, and surgical treatment was superior to other treatment methods in all controls. Significant improvement in Boston functional status scores occurred only in the surgical treatment group. In electrophysiological examination, there is a significant improvement in sensory conduction velocity, distal motor latency and sensory amplitude in surgical treatment, in motor distal latency and sensory amplitude in steroid treatment, and in sensory conduction velocity in PRP treatment. It has been shown that surgical treatment is superior to PRP treatment (p=0.049) at 3 months, surgical treatment is superior to steroid (p=0.040) and PRP (p=0.024) treatment at 6 months, and surgical treatment is superior to PRP treatment (p=0.012) at 6 months in the evaluation of motor distal latency in sensory conduction speed. There was a significant improvement in MSKA measurements in all groups at the 1st month control. Conclusion: The reduction in pain score and symptom severity was significantly better in the surgical treatment group in the early and late stages compared to the other two treatment methods. In terms of functional recovery, surgical treatment is superior to platelet-rich plasma treatment in the early and late stages, and steroid treatment at the 3rd month. In electrophysiological evaluations, the superiority of surgical treatment over steroid and platelet-rich plasma treatment in improving sensory conduction is evident in the 3rd and 6th month control. Surgical treatment may be considered as the first choice in patients with mild and moderate carpal tunnel syndrome. In the future, studies with larger patient groups and longer follow-up periods are needed.