Original Article

Comparison of Ultrasound‑Guided versus Anatomical

Landmark‑Guided Approach for Perineural Steroid Infiltration in
Carpal Tunnel Syndrome: A Prospective Randomised Controlled
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Trial
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Sonika Rathoor1, Anil Kumar Gupta2, Dileep Kumar2, Ganesh Yadav2

1
Department of Physical Medicine and Rehabilitation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, 2Department of
Physical Medicine and Rehabilitation, King George’s Medical University, Lucknow, Uttar Pradesh, India

Abstract
Background: Carpal tunnel syndrome (CTS), a compressive neuropathy is usually managed by conservative treatment and/or
decompressive surgery. Minimally invasive perineural steroid injections have been shown to be very effective in early‑onset CTS. We
evaluated the clinical efficacy and safety of ultrasound (USG)‑guided steroid injection over anatomical landmark‑guided approach in CTS.
Methodology and Results: Eighty‑four consecutive Stage I‑II primary CTS patients enrolled between August 2017 and December 2018
were randomised prospectively into two groups in 1:1 fashion. In Group I, anatomical landmark guided and in Group II, USG guided 1 ml
steroid (40 mg methylprednisolone) was injected perineurally. Symptom and functional assessments were done using Boston Carpal Tunnel
Questionnaire (BCTQ) and Visual Analogue Scale (VAS) score at 3, 6 and 12 weeks’ follow‑up. Significant improvement was seen in BCTQ
and VAS scores of both groups at 3 weeks follow‑up. At subsequent follow‑ups (at 6 and 12 weeks), marked improvement of BCTQ and VAS
scores in USG‑guided group was observed. Conclusion: USG‑guided perineural steroid injections had early‑onset significant and sustained
symptom reduction and functional improvement at 6‑ and 12‑weeks follow‑up when compared to anatomical landmark‑guided approach with
both the techniques being equally safe.

Key words: Blind approach, Boston Carpal Tunnel Questionnaire, carpal tunnel syndrome, perineural steroid injection, ultrasound‑guided
approach, Visual Analogue Scale

Introduction confirmation is made by the findings of electrodiagnostic tests

Carpal tunnel syndrome (CTS) is the most common entrapment
neuropathy with the prevalence of 2.7%–5.8%.[1‑3] It results in
pain, burning, tingling or paresthesia (exacerbated at night)
caused due to compression of median nerve in its distribution
area distal to the wrist joint. CTS is progressive in nature
with increased risk in certain population subgroups including
advanced age, female sex, diabetes mellitus, hypothyroidism,
pregnancy and people used to have prolong work on laptops,
music players, carpenters, etc. However, nowadays younger
population (20–30 years) is also being affected, primarily due
to overuse of laptops and smartphones. CTS is diagnosed on the
basis of clinical history and specific provocative physical signs,
e.g., Phalen’s test, Tinel’s sign and Durkan’s test.[4] Diagnostic
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(nerve conduction study [NCS]) and high-resolution ultrasound
(HR-USG).[5] Diagnostic sensitivity and specificity of NCS
and HR‑USG for CTS are 49%–84%, 95%, 77.6% and 86.8%,
respectively.[6,7]
Address for correspondence: Dr. Sonika Rathoor,
Department of Physical Medicine and Rehabilitation, Sanjay Gandhi
Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
E‑mail: sonikakgmc@gmail.com
Submitted: 10‑Aug‑2022 Revised: 21‑Sep‑2022
Accepted: 12‑Oct‑2022 Published: 28-Mar-2023
This is an open access journal, and articles are distributed under the terms of the Creative
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How to cite this article: Rathoor S, Gupta AK, Kumar D, Yadav G.
Comparison of ultrasound‑guided versus anatomical landmark‑guided
approach for perineural steroid infiltration in carpal tunnel syndrome:
A prospective randomised controlled trial. Indian J Phy Med Rehab
2023;33:30-6.

30 © 2023 Indian Journal of Physical Medicine & Rehabilitation | Published by Wolters Kluwer - Medknow
 Rathoor, et al.: Ultrasound versus anatomical landmark-guided steroid injection in CTS

CTS treatment essentially includes drug therapy, nocturnal CTS
splint, ergonomic modification and perineural corticosteroid
injection leading to reduction in tenosynovial volume, with
a direct effect on the median nerve [Figure 1]. Surgical
decompression of median nerve is needed in advance stage
or if conservative management fails. In the routine clinical
practice, perineural steroid injections are administered using
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Sample size
Eighty‑four consecutive patients attending Physical
Medicine and Rehabilitation and Neurology outpatient
clinic were recruited according to the inclusion and
exclusion criteria from August 2017 to December 2018.
Considering a mean prevalence of CTS in general
population being 4.25%; assuming 80% power, 5%

the anatomical landmarks only. Although major complications

significance level with 95% confidence interval and 5%
of steroid injection in carpal tunnel are very uncommon, the
margin of error, the calculated sample size came out to
risk of injury to median nerve and surrounding structures
be 66. Assuming 20% loss to follow‑up, the final sample
cannot be eliminated completely using the anatomical
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size was estimated as 84 (Charan and Saxena[12]). Patients

landmark approach. In the short‑term (<4‑weeks follow‑up),
USG‑guided injections have been proven to be safer, accurate
and efficacious in previous studies.[8‑11] In this study, we
evaluated the comparative safety and efficacy of USG‑guided
approach in CTS patients over an extended follow‑up
period (3 months).
Methodology
In this hospital based, double‑blinded, single centre, prospective
randomised control study, recently diagnosed (<1 years of
symptom onset) patients of primary or idiopathic CTS with
mild to moderate symptoms (Stage I‑II CTS) between 20 and
60 years of age were recruited. Patients having Stage III CTS,
active cervical radiculopathy, history of prior wrist fracture,
uncontrolled hyperglycaemia, local site infection or skin lesion,
drug hypersensitivity, undergone surgical treatment for CTS or
received steroid injection for CTS during previous 6 months in
the same wrist were excluded from the study. The experimental
procedures were explained to all subjects with informed written
consent obtained as per the declaration of Helsinki.
were allocated to the two experimental groups (anatomical
landmark‑guided approach and USG‑guided approach) in
1:1 fashion using computer‑generated tables with patients
and investigator being blinded to the randomization
technique [Table 1].
Z 1 − α / 2 2 p (1 − p )
Sample Size =
d2
Z1‑α/2 = Standard normal variate (at 5% Type I error [P < 0.05],
it is 1.96; at 1% Type I error [P < 0.01], it is 2.58).
p = Expected proportion in population based on previous
studies and pilot studies
d = Absolute error or precision
Procedural protocol (injection technique)
All patients were comfortably seated with the forearm
supinated and wrist in the neutral position prior to the
therapeutic interventional procedure as described below.[8,11]

a b

c
Figure 1: Sonogram in transverse (short) axis through median nerve (white solid arrow) in a patient without (a) and with CTS (b). Cross‑sectional area
of median nerve in b (marked by dotted outline) is 19 mm2 suggestive of median neuritis. Illustration showing carpal tunnel and its contents (anatomical
relationship) in transverse axis (c). CTS: Carpal tunnel syndrome, MN: Median nerve, UA: Ulnar artery, RA: Radial artery, M: Medial aspect of wrist,
Lu: Lunate carpal bone, SC: Scaphoid carpal bone

Indian Journal of Physical Medicine & Rehabilitation ¦ Volume 33 ¦ Issue 1 ¦ January-April 2023 31
 Rathoor, et al.: Ultrasound versus anatomical landmark-guided steroid injection in CTS

Table 1: Baseline clinical characteristics of the study participants

Variable Group I (n=42) Group II (n=42) Total (n=84) P
Age (years), mean±SD 46.67±6.29 46.95±6.11 46.81±6.17 0.833
Sex, n (%)
Male 7 (16.7) 3 (7.1) 10 (11.9) 0.178
Female 35 (83.3) 39 (92.9) 74 (89.1)
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BMI (kg/m2) 24.13±2.46 23.84±1.75 23.99±1.75 0.544

Overweight, n (%) 19 (45.2) 15 (35.7) 34 (40.5) 0.374
Duration of symptoms (months), n (%)
3-6 12 (28.6) 21 (50.0) 33 (39.3) 0.032*
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7-12 27 (64.3) 15 (35.7) 42 (50.0)

>12 3 (7.1) 6 (14.3) 9 (10.7)
Stage of CTS, n (%)
Stage I 15 (35.7) 12 (28.6) 27 (32.1) 0.483
Stage II 27 (64.3) 30 (71.4) 57 (67.9)
Occupation related CTS, n (%) 6 (14.3) 3 (7.1) 9 (10.7) 0.290
Hypothyroidism, n (%) 3 (7.1) 3 (7.1) 6 (7.1) 1.000
Clinical diagnostic tests
Phalen’s test 35 (83.3) 36 (85.7) 71 (84.5) 0.763
Reverse Phalen’s test 35 (83.3) 37 (88.1) 72 (85.7) 0.533
Durkan test 42 (100.0) 42 (100.0) 84 (100.0) NA
*Statistically significant values. SD: Standard deviation, BMI: Body mass index, CTS: Carpal tunnel syndrome, NA: Not available

Anatomical landmark guided approach (Group I)

After skin preparation and antisepsis, palmaris longus tendon
was palpated and 1 ml (40 mg) of methylprednisolone was
injected into the carpal tunnel using 23‑gauze needle, making
an angle of 45° with the skin surface with direction of needle
along the middle finger, at 1 cm medial to palmaris longus
tendon and 1 cm proximal to distal wrist crease[13] [Figure 2a].
Ultrasound‑guided approach (Group II)
Ulnar side in–plane approach [8,11] was used in which
transducer was placed perpendicular to median nerve at the
distal palmar crease and 1 ml (40 mg) methylprednisolone
was injected into the carpal tunnel using 23 G needle from a b
ulnar side of palmaris longus tendon with the tip of needle
Figure 2: Administration of anatomical landmark guided steroid injection
being identified as a moving reflector in real time as it passes (a). The needle is inserted at a 30° angle just medial to the palmaris longus
obliquely from skin surface into the carpal tunnel within the tendon. Administration of USG guided steroid injection using ulnar side
imaging plane of transducer.[13] The USG‑guided injections in–plane approach (b)
were performed by using a hand‑held 5–12 Hz linear array
probe (Sonoace R7; Samsung Madison Company Ltd, Seoul, The Symptom Severity Scale and the functional status scale
South Korea) [Figure 2b]. which has become a standard for evaluation of the functional
status. Pain severity was assessed on a scale of 0–10 by Visual
Outcome assessment parameters
Analogue Scale (VAS) score at baseline, 3, 6 and 12 week
Assessment of symptom severity (like pain, numbness,
follow‑up visit.
weakness, paraesthesia or clumsiness), functional status (like
difficulties with daily activities such as writing, buttoning Statistical analysis
clothes, holding a book while reading, gripping a telephone Statistical analyses were carried out using the Statistical
handle, opening jars, household chores, carrying grocery Package for the Social Sciences, software version 21.0 (SPSS,
bags, and bathing/dressing) was done by using Boston Carpal Chicago, IL, USA). Quantitative data were presented
Tunnel Questionnaire (BCTQ) at baseline, 3, 6 and 12 weeks. as mean ± standard deviation, while qualitative data
BCTQ score is a quantitative assessment of functional and were demonstrated as frequency and percent. A level of
symptomatic severity of disease and to quantify the objective significance is defined at P < 0.05. The Chi‑square test was
improvement or deterioration, post‑intervention over a used to compare the clinical efficacy and safety profile of
period in CTS patients. It comprises of 2 multi‑item scales: the USG‑guided and nonultrasound‑guided approach for

32 Indian Journal of Physical Medicine & Rehabilitation ¦ Volume 33 ¦ Issue 1 ¦ January-April 2023
 Rathoor, et al.: Ultrasound versus anatomical landmark-guided steroid injection in CTS

steroid injection in CTS patients. Independent sample t‑test
was used to compare the quantitative data between the two
groups. Tukey’s test was applied to derive significance result
from intragroup comparison of qualitative data at different
time intervals during the follow‑up. Mann–Whitney test
was applied to derive the significance result from intergroup
comparison of quantitative data at different time intervals
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improvement in BCTQ scores at 6‑and 12‑week follow‑up was
greater in Group II when compared to Group I (P < 0.001),
whereas at 3‑week follow‑up, no significant difference was
observed between the groups with respect to BCTQ score
improvement [P = 0.823, Table 2]. Moreover, on comparing
the temporal trends of improvement in BCTQ scores between
the two groups, the difference at baseline versus 3 weeks, i.e.,

during the follow‑up. Freidman test was applied to derive
significance result from intragroup comparison of quantitative
data at different time intervals during the follow‑up.
Multivariate regression analysis (linear and logistic) was
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∆BCTQ0‑3 week was observed to be higher in Group I (P = 0.025)
while there was no significant difference in ∆BCTQ0‑6 week
(P = 0.151) and ∆BCTQ0‑12 wk (P = 0.867) between the two

groups [Table 3]. Intra‑group comparison of BCTQ scores at

used to remove confounding factors affecting outcome various follow‑up revealed that the changes in these scores
assessment parameters. Bivariate correlation was used to at various follow‑up visits were highly significant in both the
derive the relationship between the two quantitative outcome groups (P < 0.001).
assessment parameters (BCTQ score and VAS score).
Overall, the mean VAS score of 84 patients at baseline was
7.06 ± 1.30. Although there was no significant difference in
Results baseline VAS score between the groups, at 3, 6, and 12‑week
Eighty‑four individuals (including 10 males and 74 females) follow‑up, both the groups showed significantly improved
with a mean age of 46.8 ± 6.2 years (range: 32–60 years) VAS score [Figure 3b]. Despite no significant difference
were enrolled into the study with 42 patients being allocated between the two groups seen in VAS score at 3 weeks from
to each group. Overall, 36 (42.9%) patients had bilateral baseline, significant better improvement in VAS score was
hand involvement with the distribution being similar in the
evident in Group II (P < 0.001) as compared to Group I
two groups (40% vs. 45%). Baseline characteristics of the
at 6‑  and 12‑week follow‑up [Table 2]. The inter‑group
patients are depicted in Table 1. No significant difference
comparison of difference in VAS scores (∆VAS) at various
was observed between the two groups with respect to age,
follow‑up revealed that ∆VAS0‑6 week and ∆VAS3‑6 week was
gender, body mass index, CTS stage, symptom/function
score (BCTQ), and VAS score. However, the distribution
of patients according to the onset of symptom duration Table 2: Group‑wise distribution of Boston Carpal Tunnel
was different in the two groups. In Group I, two‑third of Questionnaire scores at different timeline
the patients had symptoms for 7–12 months. In Group II, Follow‑up timeline Group I Group II P
50% of the patients had symptoms lasting for 3–6 months (n=42) (n=42)
prior to presentation. Only 7.1% and 14.3% patients had BCTQ score (mean±SD)
symptom duration >1 year in Groups I and II, respectively. Baseline 51.52±10.71 49.05±9.85 0.428
No major side effects (including nerve, blood vessel or any 3 weeks 31.83±6.93 32.00±6.47 0.823
soft tissue injury) were observed in any of the groups. Only 6 weeks 25.52±4.44 21.50±2.60 <0.001*
3 (7.1%) patients in anatomical landmark guided group and 12 weeks 21.24±1.72 19.60±1.06 <0.001*
1 (2.4%) patient in USG‑guided group experienced significant VAS score (mean±SD)
procedural pain. Baseline 7.05±0.96 7.07±1.58 0.576
3 weeks 3.60±0.96 3.40±1.36 0.673
At baseline, there was no difference in BCTQ scores of the 6 weeks 1.62±1.17 0.62±0.70 <0.001*
two groups; however, both groups improved significantly 12 weeks 0.57±0.80 0.02±0.15 <0.001*
at 3 week follow‑up and the improvement persisted in *Statistically significant values. SD: Standard deviation, BCTQ: Boston
further follow‑ups, i.e., at 6 and 12 weeks [Figure 3a]. The Carpal Tunnel Questionnaire, VAS: Visual analogue scale

a b
Figure 3: Comparison of BCTQ (a) and VAS scores (b) Between the groups at different timelines. BCTQ: Boston carpal tunnel questionnaire, VAS: Visual
analogue scale

Indian Journal of Physical Medicine & Rehabilitation ¦ Volume 33 ¦ Issue 1 ¦ January-April 2023 33
 Rathoor, et al.: Ultrasound versus anatomical landmark-guided steroid injection in CTS

significant between the two groups (P < 0.05) [Table 4].
Significant positive correlation was found between BCTQ
and VAS scores at baseline (P < 0.001, r = 0.794), 3 week
(P < 0.001, r = 0.584), 6 week (P < 0.001, r = 0.742), and
12 week (P < 0.001, r = 0.594) follow‑up.
Discussion
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was seen in both approaches beyond 3 weeks of initiating
therapy. However, patients with USG‑guided intervention had
significantly lower BCTQ scores at subsequent follow‑ups,
i.e., 6 and 12 weeks as compared to patients in the anatomical
landmark‑guided approach. This decremental improvement
in Group I patients may be related to relative chronicity
of the CTS symptoms as Group I had significantly more

patients (64.3%) having 7–12 months symptom duration as

This study was conducted to compare the efficacy and safety
compared to Group II where 50% patients had acute onset
of steroid injection by two different injectable methodologies,
namely anatomical landmark‑guided and USG guided, symptoms (3–6 months duration).
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in patients with CTS. Although both the modalities were
effective in improving function, pain and other symptoms yet
ultrasound‑guided injectable therapy demonstrated better,
earlier and long‑lasting symptom relief in comparison to
anatomical landmark‑guided approach. In our study, majority
of patients were females (89.1%) which is in accordance with
the currently prevalent sex‑ratio (1:9) of CTS in the general
population. This female pre‑ponderance, being multifactorial
is related to hormonal factors causing soft‑tissue edema and
increased perineural pressure, physiologic and anatomic
differences in carpal tunnel volume, and increased propensity
of being predisposed to musculoskeletal problems.[14‑18]
In our study, one‑third patients (n = 27) had Stage I CTS
and two‑thirds (n = 57) had Stage II CTS. Most of the
patients (89.3%) included in our study had onset symptoms
of <1 year as these patients were more likely to be
benefitted from local steroid injections. Patients with acute
presentation (<3 months) were not included in the study
since acute CTS that is usually related to local trauma is
rare and requires surgical exploration and decompression
wherein local steroid injections may paradoxically aggravate
the inflammation cascade and prevent healing.[18] Significant
improvement in symptomatology and functional impairment
Relative change in BCTQ score from baseline was more
in Group I (∆BCTQ0‑3 week = 19.69 ± 7.84) at 3 weeks as
compared to Group II (∆BCTQ0‑3 week = 17.05 ± 5.03). This
significant difference in ∆BCTQ0‑3 week score between the two
groups could be due to marginally higher baseline BCTQ
scores in Group I compared to Group II. ∆BCTQ between
3 and 6 week was significantly more in USG‑guided group
compared to landmark‑guided group and ∆BCTQ between
6 and 12 weeks in USG‑guided group was significantly
less than the blind approach group depicting that there
was significantly more improvement in BCTQ score up to
6 weeks in USG guided group. Since BCTQ had already been
drastically reduced at 6 weeks; hence, no further significant
improvement was noticeable in USG‑guided group as
compared to landmark‑guided approach at 12‑week follow‑up.
Similar to our findings, Grassi et al.[19] showed that there
was clinical improvement at 3 and 6 weeks after US guided
steroid injection in CTS patient secondary to tenosynovitis in
patient with rheumatoid arthritis, but this improvement did
not persist beyond 6 weeks. Similarly, Ustün et al.[11] also
reported no significant difference in improvement in BCTQ
scores between the two groups at 6 weeks, but there was
significant improvement in symptom severity component of

Table 3: Comparison of change in Boston Carpal Tunnel Questionnaire score (∆ Boston Carpal Tunnel Questionnaire) at
various follow‑up between the groups
Change in BCTQ score (∆BCTQ)
Baseline versus Baseline versus Baseline versus 3 weeks versus 3 weeks versus 6 weeks versus
3 weeks 6 weeks 12 weeks 6 weeks 12 weeks 12 weeks
Group I 19.69±7.84 26.00±8.37 30.29±10.18 6.31±4.10 10.60±6.22 4.29±3.60
Group II 17.05±5.03 27.55±8.12 29.45±9.39 10.50±4.68 12.40±6.01 1.90±2.13
P 0.025** 0.151 0.867 <0.001* 0.07 <0.01*
*P<0.05, **P<0.01. BCTQ=Boston Carpal Tunnel Questionnaire

Table 4: Comparison of change in visual analogue scale score (∆ visual analogue scale) at various follow‑up between
the groups
Change in VAS score (∆ VAS)
Baseline versus Baseline versus Baseline versus 3 weeks versus 3 weeks versus 6 weeks versus
3 weeks 6 weeks 12 weeks 6 weeks 12 weeks 12 weeks
Group I 3.45±0.80 5.43±1.06 6.48±0.99 1.98±0.92 3.02±0.95 1.05±0.82
Group II 3.67±0.65 6.45±1.23 7.05±1.59 2.79±1.02 3.38±1.36 0.60±0.66
P >0.05 <0.05* >0.05 <0.05* >0.05 >0.05
*P<0.05. VAS: Visual analogue scale

34 Indian Journal of Physical Medicine & Rehabilitation ¦ Volume 33 ¦ Issue 1 ¦ January-April 2023
 Rathoor, et al.: Ultrasound versus anatomical landmark-guided steroid injection in CTS
BCTQ score at 12‑week in USG‑guided group without any
difference in functional severity component of BCTQ score
at 6–12 weeks follow‑up. In a study conducted by Eslamian
et al.,[8] 50% patients in landmark‑guided group and 46% in
USG‑guided group showed improvement in symptom severity
component of BCTQ score while only one‑third patients in
both the groups showed improvement in functional severity
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component of BCTQ score at 12 weeks. Contrastingly, in our
study, significant improvement was seen with USG‑guided
therapy in terms of overall BCTQ score after 3 weeks of
treatment which improved further at 6 weeks lasting up to
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3‑month follow‑up.
Our study showed improvement of VAS score in both
groups at 3 weeks with further relief in pain over subsequent
follow‑ups which was relatively more in USG‑guided group
(∆VAS3‑6 week = 2.79 ± 1.02) in comparison to anatomical
landmark‑guided approach (∆VAS3‑6 week = 1.98 ± 0.92), thereby
depicting significant pain relief using injectable therapy.
However, USG‑guided approach was demonstrated to be
more efficacious as compared to anatomical landmark‑guided
approach which was similar to the findings of Makhlouf et al.[20]
who reported that USG‑guided injection in carpal tunnel when
compared to anatomic landmark guided injection resulted in
77.1% reduction in procedural pain and 63.3% reduction in
pain scores at 2 weeks and 6 months follow‑up. On the other
hand, an objective assessment of pain relief was surprisingly,
not done in many of the previous studies.[8,11,19]
Although steroid injection in CTS is safe but occasionally,
complications such as median nerve and soft‑tissue injury
have been reported. Racasan and Dubert[21] demonstrated that
injection instilled within 1 cm of ulnar or radial side of palmaris
longus tendon enhances the risk of median nerve injury. In
our study, both groups were similar in terms of adverse major
side effects. Only few patients reported transient procedural
pain during in both groups, which were resolved after therapy
which was consistent with the findings of Ustün et al.[11] and
Eslamian et al.[8] The advantage of in‑plane USG‑guided
injection over blind approach was due to the real‑time imaging
capability of USG which enables definite visualization of the
needle tip continuously ensuring that needle is placed at the
desired location without any damage of median nerve and
surrounding structure. Moreover, it assists in visualizing the
distribution of the material injected in real time. Consequently,
significant and long‑lasting improvement in recipients of
USG‑guided injectable steroids has been postulated because
of the aforementioned mechanisms.
Study limitations
The present study does have some limitations. Primarily, since it
is a single‑centre study with female preponderance in the study
sample, it would have been better if we could have recruited
more male patients from multiple sites/centres. Secondarily,
there was lack of triple blinding in the trial design. Third,
long‑term follow‑up beyond 3 months was not available for
the analysis. Fourth, lack of electro‑physiological evaluation
Indian Journal of Physical Medicine & Rehabilitation ¦ Volume 33 ¦ Issue 1 ¦ January-April 2023
as an assessment parameter for gauging the effectiveness of a
particular treatment would have come handy in elevating the
objective value of outcome variables since it has previously
been proven in other studies that there is correlation between
the clinical symptoms and electrophysiological findings.[22‑24]
Finally, the presence of few non‑homogeneous variables at
baseline (e.g., duration of symptoms) in both groups could
have played the role of confounding factors but multivariate
regression analysis has been employed in statistical analysis
to overcome this discrepancy. Employing this study as a
directive, it is thus recommended that larger studies in future
with longer follow‑up, different in‑plane USG approaches with
proper blinding and determination of electro physiologic and
USG parameters such as median cross section and FR ratio as
outcome variables should be conducted.
Conclusion
This study compares the effectiveness of administering
perineural steroid injections via USG guided or blind approach
in CTS patients. To the best of our knowledge, this is the first
Indian study to compare the efficacy of two approaches in
patients of CTS. We found out that although both US‑guided
and landmark‑guided steroid injections were effective in
reducing the symptoms of CTS and improving the function, an
earlier and massive impact on symptom relief in USG‑guided
group suggests that this approach may be more effective
than anatomical landmark‑guided approach in the short‑term
follow‑up.
Acknowledgement
We recognise the contribution of Dr. Ankit Kumar Sahu,
Associate professor in the department of cardiology at
Sanjay Gandhi Post‑graduate Institute of Medical Sciences
for proof reading of the text, table styling, figure refinement
and collation.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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