Annals of Clinical Neurophysiology

  • 제15권1호
  • /
  • Pages.7-12
  • /
  • 2013
  • /
  • 2508-691X(pISSN)
  • /
  • 2508-6960(eISSN)
대한임상신경생리학회 (The Korean Society of Clinical Neurophysiology)
권호 표지

수근관증후군에서 국소 스테로이드 주사 후 임상적, 전기생리학적 변화

Clinical and Electrophysiological Changes after Local Steroid Injection in the Carpal Tunnel Syndrome

  • 김지훈 (건양대학교병원 신경과) ;
  • 이기욱 (건양대학교병원 신경과) ;
  • 윤보라 (건양대학교병원 신경과) ;
  • 김용덕 (건양대학교병원 신경과) ;
  • 정언석 (건양대학교병원 산부인과) ;
  • 나상준 (건양대학교병원 신경과)
  • Kim, Jihoon (Department of Neurology, Konyang University Hospital) ;
  • Lee, Kee Ook (Department of Neurology, Konyang University Hospital) ;
  • Yoon, Bora (Department of Neurology, Konyang University Hospital) ;
  • Kim, Yong-Duk (Department of Neurology, Konyang University Hospital) ;
  • Jung, Un Suk (Department of Obstetrics and Gynecology, Konyang University Hospital) ;
  • Na, Sang-Jun (Department of Neurology, Konyang University Hospital)
  • 투고 : 2013.01.15
  • 심사 : 2013.06.03
  • 발행 : 2013.06.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Local steroid injection is used to treat carpal tunnel syndrome (CTS). The aim of this study was to evaluate the clinical and electrophysiological effects of local steroid injection in patients with CTS over a 3-months period. Methods: Twenty-one patients (35 hands) with clinical and electrophysiological evidence of CTS were treated by injection of triamcinolone 40 mg to the carpal tunnel. Visual analog scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), rates of paresthesia, night awakening, and electrophysiological studies were used as outcomes. Clinical and electrophysiological assessments were performed before, 1 and 3 months after treatment. Results: Prior to treatment, 86% of patients complained of night awakening. At 1 and 3 months after injection, only 17% and 29% of the patients, respectively, had night awakening (p<0.001). All patients complained of paresthesia before the treatment. This symptom disappeared in 60% and 31% of the patients after 1 and 3 months, respectively (p<0.001). Compared to baseline, both BCTQ and VAS show significant improvement during the 3 months of the study (p<0.005). Although significant improvements in clinical parameters were shown, electrophysiological parameters were not significantly improved at 1 and 3 months. Conclusions: Local corticosteroid injection for the treatment of CTS provides significant improvement in symptoms for 3 months. On the other hand, no significant improvement was observed in electrophysiological parameters.

키워드

참고문헌

  1. Dawson DM. Entrapment neuropathies of the upper extremities. N Engl J Med 1993;329:2013-2018. https://doi.org/10.1056/NEJM199312303292707
  2. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999;282:153-158. https://doi.org/10.1001/jama.282.2.153
  3. Jablecki CK, Andary MT, Floeter MK, Miller RG, Quartly CA, Vennix MJ, et al. Practice parameter: Electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2002;58:1589-1592. https://doi.org/10.1212/WNL.58.11.1589
  4. Boeckstyns MEH, Sørensen AI. Does endoscopic carpal tunnel release have a higher rate of complications than carpal tunnel release. An analysis of published series. J Hand Surg 1999;24: 9-15. https://doi.org/10.1016/S0266-7681(99)90009-8
  5. Gerritsen AA, de Vet HC, Scholten RJ, Bertelsmann FW, de Krom MC, Bouter LM. Splinting versus surgery in the treatment of carpal tunnel syndrome. A randomized controlled trial. JAMA 2002;288:1245-1251. https://doi.org/10.1001/jama.288.10.1245
  6. Chang MH, Chiang HT, Lee SS, Ger LP, Lo YK. Oral drug of choice in carpal tunnel syndrome. Neurology 1998;51:390-393. https://doi.org/10.1212/WNL.51.2.390
  7. Chang MH, Ger LP, Hsieh PF, Huang SY. A randomised clinical trial of oral steroids in the treatment of carpal tunnel syndrome: a long term follow up. J Neurol Neurosurg Psychiatry 2002;73:710-714. https://doi.org/10.1136/jnnp.73.6.710
  8. Ebenbichler GR, Resch KL, Nicolakis P, Wiesinger GF, Uhl F, Ghanem AH, et al. Ultrasound treatment for treating the carpal tunnel syndrome: randomised "sham" controlled trial. BMJ 1998;316:731-735. https://doi.org/10.1136/bmj.316.7133.731
  9. Dammers JW, Veering MM, Vermeulen M. Injection with methyl prednisolone proximal to the carpal tunnel: randomized double blind trial. BMJ 1999;319:884-886. https://doi.org/10.1136/bmj.319.7214.884
  10. Girlanda P, Dattola R, Venuto C, Mangiapane R, Nicolosi C, Messina C. Local steroid treatment in idiopathic carpal tunnel syndrome: short- and long-term efficacy. J Neurol 1993;240: 187-190. https://doi.org/10.1007/BF00857526
  11. Gelberman RH, Aronson D, Weisman MH. Carpal tunnel syndrome: results of a prospective trial of steroid injection and splinting. J Bone Joint Surg Am 1980;62:1181-1184. https://doi.org/10.2106/00004623-198062070-00020
  12. Hagebeuk EE, DeWeerd AW. Clinical and electrophysiological follow-up after local steroid injection in the carpal tunnel syndrome. Clin Neurophysiol 2004;115:1464-1468. https://doi.org/10.1016/j.clinph.2004.01.005
  13. Agarwal V, Singh R, Sachdev A, Wiclaff, Shekhar S, Goel D. A prospective study of the long-term efficacy of local methyl prednisolone acetate injection in the management of mild carpal tunnel syndrome. Rheumatology 2005;44:647-650. https://doi.org/10.1093/rheumatology/keh571
  14. Milo R, Kalichman L, Volchek L, Reitblat T. Local corticosteroid treatment for carpal tunnel syndrome: A 6-month clinical and electrophysiological follow-up study. J Back Musculoskelet Rehabil 2009;22:59-64. https://doi.org/10.3233/BMR-2009-0214
  15. Sevim S, Dogu O, Camdeviren H, Kaleagasi H, Aral M, Arslan E, et al. Long-term effectiveness of steroid injections and splinting in mild and moderate carpal tunnel syndrome. Neurol Sci 2004;25:48-52.
  16. O'Gradaigh D, Merry P. Corticosteroid injection for the treatment of carpal tunnel syndrome. Ann Rheum Dis 2000;59:918-919. https://doi.org/10.1136/ard.59.11.918
  17. Giannini F, Passero S, Cioni R, Paradiso C, Battistini N, Giordano N, et al. Electrophysiologic evaluation of local steroid injection in carpal tunnel syndrome. Arch Phys Med Rehabil 1991;72:738-742.
  18. Visser LH, Ngo Q, Groeneweg SJ, Brekelmans G. Long term effect of local corticosteroid injection for carpal tunnel syndrome: a relation with electrodiagnostic severity. Clin Neurophysiol 2012; 123:838-841. https://doi.org/10.1016/j.clinph.2011.08.022
  19. American Academy of Neurology. Practice parameter for carpal tunnel syndrome (summary statement). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 1993;43:2406-2409. https://doi.org/10.1212/WNL.43.11.2406
  20. Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am 1993;75:1585-1592. https://doi.org/10.2106/00004623-199311000-00002
  21. Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev 2007;CD001554.
  22. Hui AC, Wong S, Leung CH, Tong P, Mok V, Poon D, et al. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. Neurology 2005;64:2074-2078. https://doi.org/10.1212/01.WNL.0000169017.79374.93
  23. Jenkins PJ, Duckworth AD, Watts AC, McEachan JE. Corticosteroid injection for carpal tunnel syndrome: a 5-year survivorship analysis. HAND 2012;7:151-156. https://doi.org/10.1007/s11552-012-9390-8
  24. Katz JN, Keller RB, Simmons BP, Rogers WD, Bessette L, Fossel AH, et al. Maine Carpal Tunnel Study: outcomes of operative and nonoperative therapy for carpal tunnel syndrome in a community-based cohort. J Hand Surg Am 1998;23:697-710. https://doi.org/10.1016/S0363-5023(98)80058-0
  25. Verdugo RJ, Salinas RA, Castillo JL, Cea JG. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev 2008;CD001552.
  26. Ly-Pen D, Andreu JL, de Blas G, Sanchez-Olaso A, Millan I. Surgical decompression versus local steroid injection in carpal tunnel syndrome: a one-year, prospective, randomized, open, controlled clinical trial. Arthritis Rheum 2005;52:612-619. https://doi.org/10.1002/art.20767
  27. Demirci S, Kutluhan S, Koyuncuoglu HR, Kerman M, Heybeli N, Akkuş S, et al. Comparison of open carpal tunnel release and local steroid treatment outcomes in idiopathic carpal tunnel syndrome. Rheumatol Int 2002;22:33-37. https://doi.org/10.1007/s00296-002-0184-0
  28. Padua L, Padua R, Aprile I, Pasqualetti P, Tonali P. Multiperspective follow-up of untreated carpal tunnel syndrome: a multicenter study. Neurology 2001;56:1459-1466. https://doi.org/10.1212/WNL.56.11.1459