مقايسه يافته‌هاي سونوگرافي سندرم تونل كارپ، قبل و بعد از تزريق كورتيكوستروئيد

Comparison of Ultrasound Findings of Carpal Tunnel Syndrome before and after Corticosteroid Injection

ﺳﻨﺪرم ﺗﻮﻧﻞ ﮐﺎرپ ﺷﺎيﻊ‌ﺗﺮيﻦ ﻧﻮروﭘﺎﺗﯽ ﻣﺤﯿﻄﯽ به دليل به دام افتادن ﻋﺼﺐ اﺳـﺖ. ﺗﺸﺨﻴﺺ اين سندرم ﺑﺮاﺳﺎس ﻋﻼﺋﻢ ﺑﺎﻟﻴﻨﻲ و تأييد آن با استفاده از مطالعات الكترودياگنوستيك صورت مي‌گيرد. اولتراسونوگرافي يك روش بي‌خطر، در دسترس براي پيگيري بيماران و ارزشمند مي‌باشد. در اين راستا، مطالعه حاضر با هدف بررسي يافته‌هاي سونوگرافيك قبل و بعد از تزريق كورتيكوستروئيد انجام شد. مواد و روش‌‌ها: در مطالعه مداخله‌اي حاضر، 45 بيمار با علائم سندرم تونل كارپ و مطالعات الكترودياگنوستيك مثبت كه حاكي از درجه متوسط بيماري بود، در طول سال 1396 به درمانگاه ارتوپدي بيمارستان بعثت همدان مراجعه كرده و به روش نمونه‌گيري آسان انتخاب شدند. سونوگرافي مچ دست انجام شد و پس از تزريق كورتيكوستروئيد و گذشت دو ماه مجدداً مورد سونوگرافي قرار گرفتند. شاخص‌هاي سونوگرافي قبل و بعد از تزريق مقايسه گرديد. نتيجه‌گيري: كورتيكوستروئيد در بيماران مبتلا به اين سندرم با شدت متوسط موجب بهبود علائم باليني مي‌شود كه اين بهبودي با كاهش ضخامت عصب مدين، فلكسور رتيناكولوم و سطح مقطع عصب همراه است.

Carpal Tunnel Syndrome is the most prevalent type of peripheral neuropathy due to neural entrapment. This syndrome is primarily diagnosed based on clinical symptoms, and it is subsequently confirmed by electro-diagnostic studies. Ultrasonography as a safe, available, and inexpensive method is also valuable in the follow-up of patients. This study aimed to evaluate the ultrasound findings before and after local corticosteroid injection. Materials and Methods: This interventional study was conducted on 45 patients referring to the orthopedic clinic of Besat Hospital, Hamadan, Iran, during 2017. The patients who were selected by convenient sampling method had the symptoms of carpal tunnel syndrome and were diagnosed positive based on electrodiagnostic studies indicating a moderate grade of the disease. Wrist ultrasound was performed before and after the injection of corticosteroid (two months later). Moreover, the ultrasound indices were compared before and after the injection. Data were analyzed in SPSS software (version 16). A p-value less than 0.05 was considered statistically significant. Results: According to the results, 80% of the patients were female. Moreover, the mean age of the patients was 47.9±11.6 years (age range: 22-72 years). About 20% of the cases were left-handed. The right hand was mostly affected by carpal tunnel syndrome (70%). After injection, there were reductions in the median nerve thickness (P=0.95), retinaculum thickness (P=0.001), and nerve cross-sectional area (P=0.001). The Disabilities of the Arm, Shoulder, and Hand (DASH) scale showed that the clinical symptoms of the patients were significantly reduced at the end of the study (P=0.001). Conclusion: Corticosteroid injection in patients with moderate severity of carpal tunnel syndrome improved the clinical symptoms and caused reductions in median nerve thickness, cross-sectional area, and flexor retinaculum thickness.