Neuromuscular DiseasesNeuromuscular DiseasesНервно-мышечные болезни2222-87212413-0443Publishing House ABV Press25810.17650/2222-8721-2018-8-1-10-19LECTURES AND REVIEWSЛЕКЦИИ И ОБЗОРЫLocal administration of corticosteroids in treatment of carpal tunnel syndromeИспользование локального введения кортикостероидов при лечении синдрома запястного каналаhttps://orcid.org/0000-0002-6752-3311KiselevV. N.КиселевВ. Н.
Russian Federation
kiselev.neurologist@gmail.comhttps://orcid.org/0000-0002-2913-3443AleksandrovN. Yu.АлександровН. Ю.
Russian Federation
https://orcid.org/0000-0002-4960-3780KorotkevichM. M.КороткевичМ. М.
Russian Federation
A.M. Nikiforov Russian Center of Emergency and Radiation Medicine, Ministry for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters of RussiaФГБУ «Всероссийский центр экстренной и радиационной медицины им. А.М. Никифорова» МЧС РоссииI.I. Mechnikov North-Western State Medical University, Ministry of Health of RussiaФГБОУ ДПО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава РоссииA.L. Polenov Russian Research Institute of Neurosurgery (branch of the V.A. Almazov National Medical Research Center, Ministry of Health of Russia)Российский научно-исследовательский нейрохирургический институт им. проф. А.Л. Поленова (филиал ФГБУ «Национальный медицинский исследовательский центр им. В.А. Алмазова» Минздрава России)300420188110193004201830042018Copyright ©; 2018, Kiselev V.N., Aleksandrov N.Y., Korotkevich M.M.Copyright ©; 2018, Киселев В.Н., Александров Н.Ю., Короткевич М.М.2018Kiselev V.N., Aleksandrov N.Y., Korotkevich M.M.Киселев В.Н., Александров Н.Ю., Короткевич М.М.https://creativecommons.org/licenses/by/4.0https://nmb.abvpress.ru/jour/article/view/258

Carpal tunnel syndrome is the most frequent entrapment neuropathy. We performed a literature review of application of local corticosteroid injections. The main aim of the review is to outline the issues concerning indications for the treatment, efficiency and safety of the procedure, and the effect’s duration. Different techniques and different types of corticosteroids, outcomes of the local injections in comparsion with surgical treatment are discussed.

Синдром запястного канала – наиболее часто встречающаяся туннельная нейропатия. В настоящей статье представлен обзор литературы, посвященный использованию локального введения кортикостероидов при лечении данной патологии. Рассмотрены вопросы эффективности и безопасности процедуры, существующие модификации ее выполнения. Определены показания к применению, обсуждено использование различных кортикостероидов, проведено сравнение локальных инъекций и хирургического лечения.

 

median nervecarpal tunnel syndromeentrapment neuropathycorticosteroidlocal injectionelectromyographyсрединный нервсиндром запястного каналатуннельная нейропатиякортикостероидлокальная инъекцияэлектромиография1. De Krom M.C., Knipschild P.G., Kester A.D. et al. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol 1992;45(4):373–6. DOI: 10.1016/0895-4356(92)90038-o. PMID: 1569433.De Krom M.C., Knipschild P.G., Kester A.D. et al. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol 1992;45(4):373–6. DOI: 10.1016/0895-4356(92)90038-o. PMID: 1569433.2. Atroshi I., Gummesson C., Johnsson R. et al. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999;282(2):153–8. DOI: 10.1001/ jama.282.2.153. PMID: 10411196.Atroshi I., Gummesson C., Johnsson R. et al. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999;282(2):153–8. DOI: 10.1001/ jama.282.2.153. PMID: 10411196.3. Werner R., Armstrong T., Bir C., Aylard M.K. Intracarpal canal pressures: the role of finger, hand, wrist and forearm position. Clin Biomech 1997;12(1):44–51. DOI: 10.1016/S0268-0033(96)00044-7. PMID: 11415671.Werner R., Armstrong T., Bir C., Aylard M.K. Intracarpal canal pressures: the role of finger, hand, wrist and forearm position. Clin Biomech 1997;12(1):44–51. DOI: 10.1016/S0268-0033(96)00044-7. PMID: 11415671.4. Sunderland S. The nerve lesion in the carpal tunnel syndrome. J Neurol Neurosurg Psychiatry 1976;39(7):615–26. DOI: 10.1136/jnnp.39.7.615. PMID: 993794.Sunderland S. The nerve lesion in the carpal tunnel syndrome. J Neurol Neurosurg Psychiatry 1976;39(7):615–26. DOI: 10.1136/jnnp.39.7.615. PMID: 993794.5. Aboonq M.S. Pathophysiology of carpal tunnel syndrome. Neurosciences (Riyadh) 2015;20(1):4–9. PMID: 25630774.Aboonq M.S. Pathophysiology of carpal tunnel syndrome. Neurosciences (Riyadh) 2015;20(1):4–9. PMID: 25630774.6. Hakim A.J., Cherkas L., El Zayat S. et al. The genetic contribution to carpal tunnel syndrome in women: a twin study. Arthritis Rheum 2002;47(3):275–9. DOI: 10.1002/ art.10395. PMID: 2115157.Hakim A.J., Cherkas L., El Zayat S. et al. The genetic contribution to carpal tunnel syndrome in women: a twin study. Arthritis Rheum 2002;47(3):275–9. DOI: 10.1002/ art.10395. PMID: 2115157.7. Bland J. The relationship of obesity, age, and carpal tunnel syndrome: more complex than was thought. Muscle Nerve 2005;32(4):527–32. DOI: 10.1002/ mus.20408. PMID: 16025527.Bland J. The relationship of obesity, age, and carpal tunnel syndrome: more complex than was thought. Muscle Nerve 2005;32(4):527–32. DOI: 10.1002/ mus.20408. PMID: 16025527.8. Bongers F., Schellevis F., van den Bosch W. et al. Carpal tunnel syndrome in general practice: incidence and the role of occupational and nonoccupational factors. Br J Gen Pract 2007;57:36–9. PMID: 17244422.Bongers F., Schellevis F., van den Bosch W. et al. Carpal tunnel syndrome in general practice: incidence and the role of occupational and nonoccupational factors. Br J Gen Pract 2007;57:36–9. PMID: 17244422.9. Aroori S., Spence R.A. Carpal tunnel syndrome. Ulster Med J 2008;77(1):6–17. PMID: 18269111.Aroori S., Spence R.A. Carpal tunnel syndrome. Ulster Med J 2008;77(1):6–17. PMID: 18269111.10. Ibrahim I., Khan W.S., Goddard N., Smitham P. Carpal tunnel syndrome: a review of the recent literature. Open Orthop J 2012;6:69–76. DOI: 10.2174/1874325001206010069. PMID: 3314870.Ibrahim I., Khan W.S., Goddard N., Smitham P. Carpal tunnel syndrome: a review of the recent literature. Open Orthop J 2012;6:69–76. DOI: 10.2174/1874325001206010069. PMID: 3314870.11. Werner R.A., Andary M. Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve 2011;44(4):597–607. DOI: 10.1002/mus.22208. PMID: 21922474.Werner R.A., Andary M. Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve 2011;44(4):597–607. DOI: 10.1002/mus.22208. PMID: 21922474.12. Chen Y.T., Williams L., Zak M.J., Fredericson M. Review of ultrasonography in the diagnosis of carpal tunnel syndrome and a proposed scanning protocol. J Ultrasound Med 2016;35(11):2311–24. DOI: 10.7863/ultra.15.12014. PMID: 27629754.Chen Y.T., Williams L., Zak M.J., Fredericson M. Review of ultrasonography in the diagnosis of carpal tunnel syndrome and a proposed scanning protocol. J Ultrasound Med 2016;35(11):2311–24. DOI: 10.7863/ultra.15.12014. PMID: 27629754.13. Stevens J.C. AAEM minimonograph #26: the electrodiagnosis of carpal tunnel syndrome. Muscle Nerve 1997;20(12): 1477–86. DOI: 10.1002/(sici)1097- 4598(199712)20:123.3.co;2-k. PMID: 9390659.Stevens J.C. AAEM minimonograph #26: the electrodiagnosis of carpal tunnel syndrome. Muscle Nerve 1997;20(12): 1477–86. DOI: 10.1002/(sici)1097- 4598(199712)20:123.3.co;2-k. PMID: 9390659.14. Padua L., Lo Monaco M., Padua R. et al. Neurophysiological classification of carpal tunnel syndrome: assessment of 600 symptomatic hands. Ital J Neurol Sci 1997;18(3):145–50. DOI: 10.1007/ BF02048482. PMID: 9241561.Padua L., Lo Monaco M., Padua R. et al. Neurophysiological classification of carpal tunnel syndrome: assessment of 600 symptomatic hands. Ital J Neurol Sci 1997;18(3):145–50. DOI: 10.1007/ BF02048482. PMID: 9241561.15. Marshall S., Tardif G., Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev 2007;18(2):CD001554. DOI: 10.1002/14651858.CD001554.pub2. PMID: 17443508.Marshall S., Tardif G., Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev 2007;18(2):CD001554. DOI: 10.1002/14651858.CD001554.pub2. PMID: 17443508.16. Page M.J., Massy-Westropp N., O’Connor D. et al. Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev 2012(7): CD010003. DOI: 10.1002/14651858. PMID: 22786532.Page M.J., Massy-Westropp N., O’Connor D. et al. Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev 2012(7): CD010003. DOI: 10.1002/14651858. PMID: 22786532.17. Agee J.M., McCarroll H.R. Jr, Tortosa R.D. et al. Endoscopic release of the carpal tunnel: a randomized prospective multicenter study. J Hand Surg Am 1992;17(6): 987–95. DOI: 10.1016/s0363- 5023(09)91044-9. PMID: 1430964.Agee J.M., McCarroll H.R. Jr, Tortosa R.D. et al. Endoscopic release of the carpal tunnel: a randomized prospective multicenter study. J Hand Surg Am 1992;17(6): 987–95. DOI: 10.1016/s0363- 5023(09)91044-9. PMID: 1430964.18. Ariyan S., Watson H.K. The palmar approach for the visualization and release of the carpal tunnel. An analysis of 429 cases. Plast Reconstr Surg 1977;60(4):539–47. DOI: 10.1097/00006534-197710000- 00007. PMID: 909963.Ariyan S., Watson H.K. The palmar approach for the visualization and release of the carpal tunnel. An analysis of 429 cases. Plast Reconstr Surg 1977;60(4):539–47. DOI: 10.1097/00006534-197710000- 00007. PMID: 909963.19. Huisstede B.M., Friden J., Coert J.H. et al. Carpal tunnel syndrome: hand surgeons, hand therapists, and physical medicine and rehabilitation physicians agree on a multidisciplinary treatment guideline – results from the European HANDGUIDE Study. Arch Phys Med Rehabil 2014;95(12):2253–63. DOI: 10.1016/j. apmr.2014.06.022. PMID: 25127999.Huisstede B.M., Friden J., Coert J.H. et al. Carpal tunnel syndrome: hand surgeons, hand therapists, and physical medicine and rehabilitation physicians agree on a multidisciplinary treatment guideline – results from the European HANDGUIDE Study. Arch Phys Med Rehabil 2014;95(12):2253–63. DOI: 10.1016/j. apmr.2014.06.022. PMID: 25127999.20. Graham B., Peljovich A.E., Afra R. et al. The American academy of orthopaedic surgeons evidence-based clinical practice guideline on. J Bone Joint Surg 2016;98(20):1750–4. DOI: 10.2106/ JBJS.16.00719. PMID: 27869627.Graham B., Peljovich A.E., Afra R. et al. The American academy of orthopaedic surgeons evidence-based clinical practice guideline on. J Bone Joint Surg 2016;98(20):1750–4. DOI: 10.2106/ JBJS.16.00719. PMID: 27869627.21. Kopell H.P. Carpal tunnel compression median neuropathy treated nonsurgically. NY State J Med 1958;58(5):744–5. PMID: 13517554.Kopell H.P. Carpal tunnel compression median neuropathy treated nonsurgically. NY State J Med 1958;58(5):744–5. PMID: 13517554.22. Dammers J.W., Veering M.M., Vermeulen M. Injection with methylprednisolone proximal to the carpal tunnel: randomised double blind trial. BMJ 1999;319(7214):884–6. DOI: 10.1136/bmj.319.7214.884. PMID: 10506042.Dammers J.W., Veering M.M., Vermeulen M. Injection with methylprednisolone proximal to the carpal tunnel: randomised double blind trial. BMJ 1999;319(7214):884–6. DOI: 10.1136/bmj.319.7214.884. PMID: 10506042.23. Habib G.S., Badarny S., Rawashdeh H. A novel approach of local corticosteroid injection for the treatment of carpal tunnel syndrome. Clin Rheumatol 2006;25(3):338–40. DOI: 10.1007/ s10067-005-0002-7. PMID: 16249829.Habib G.S., Badarny S., Rawashdeh H. A novel approach of local corticosteroid injection for the treatment of carpal tunnel syndrome. Clin Rheumatol 2006;25(3):338–40. DOI: 10.1007/ s10067-005-0002-7. PMID: 16249829.24. Bland J.D. Treatment of carpal tunnel syndrome. Muscle Nerve 2007;36(2): 167–71. DOI: 10.1002/mus.20802. PMID: 17534984.Bland J.D. Treatment of carpal tunnel syndrome. Muscle Nerve 2007;36(2): 167–71. DOI: 10.1002/mus.20802. PMID: 17534984.25. Lee J.Y., Park Y., Park K.D. et al. Effectiveness of ultrasoundguided carpal tunnel injection using in-plane ulnar approach: a prospective, randomized, single-blinded study. Medicine (Baltimore) 2014;93(29):350. DOI: 10.1097/ MD.0000000000000350. PMID: 25546691.Lee J.Y., Park Y., Park K.D. et al. Effectiveness of ultrasoundguided carpal tunnel injection using in-plane ulnar approach: a prospective, randomized, single-blinded study. Medicine (Baltimore) 2014;93(29):350. DOI: 10.1097/ MD.0000000000000350. PMID: 25546691.26. Tavares S., Giddins G. Nerve injury following steroid injection for carpal tunnel syndrome. A report of two cases. J Hand Surg Br 1996;21(2):208–9. DOI: 10.1016/ s0266-7681(96)80099-4. PMID: 8732402.Tavares S., Giddins G. Nerve injury following steroid injection for carpal tunnel syndrome. A report of two cases. J Hand Surg Br 1996;21(2):208–9. DOI: 10.1016/ s0266-7681(96)80099-4. PMID: 8732402.27. Kim H.J., Park S.H. Median nerve injuries caused by carpal tunnel injections. Korean J Pain 2014;27(2):112–7. DOI: 10.3344/ kjp.2014.27.2.112. PMID: 24748938.Kim H.J., Park S.H. Median nerve injuries caused by carpal tunnel injections. Korean J Pain 2014;27(2):112–7. DOI: 10.3344/ kjp.2014.27.2.112. PMID: 24748938.28. Payne J.M., Brault J.S. Digital ischemia after carpal tunnel injection: a case report. Arch Phys Med Rehabil 2008;89(8): 1607–10. DOI: 10.1016/j. apmr.2007.11.064. PMID: 18674994.Payne J.M., Brault J.S. Digital ischemia after carpal tunnel injection: a case report. Arch Phys Med Rehabil 2008;89(8): 1607–10. DOI: 10.1016/j. apmr.2007.11.064. PMID: 18674994.29. Gottlieb N.L. Complications of local corticosteroid injections. JAMA 1980;243(15):1547–8. DOI: 10.1001/ jama.1980.03300410035021. PMID: 6965736.Gottlieb N.L. Complications of local corticosteroid injections. JAMA 1980;243(15):1547–8. DOI: 10.1001/ jama.1980.03300410035021. PMID: 6965736.30. Brinks A., Koes B.W., Volkers A.C. et al. Adverse effects of extra-articular corticosteroid injections: a systematic review. BMC Musculoskeletal Disord 2010;11(1):206. DOI: 10.1186/1471-2474- 11-206. PMID: 20836867.Brinks A., Koes B.W., Volkers A.C. et al. Adverse effects of extra-articular corticosteroid injections: a systematic review. BMC Musculoskeletal Disord 2010;11(1):206. DOI: 10.1186/1471-2474- 11-206. PMID: 20836867.31. Smith J., Wisniewski S.J., Finnoff J.T., Payne J.M. Sonographically guided carpal tunnel injections: the ulnar approach. J Ultrasound Med 2008;27(10):1485–90. DOI: 10.7863/jum.2008.27.10.1485. PMID: 18809959.Smith J., Wisniewski S.J., Finnoff J.T., Payne J.M. Sonographically guided carpal tunnel injections: the ulnar approach. J Ultrasound Med 2008;27(10):1485–90. DOI: 10.7863/jum.2008.27.10.1485. PMID: 18809959.32. Kim D.H., Jang J.E., Park B.K. Anatomical basis of ulnar approach in carpal tunnel injection. Pain Physician 2013;16(3):191– 98. PMID: 23703418.Kim D.H., Jang J.E., Park B.K. Anatomical basis of ulnar approach in carpal tunnel injection. Pain Physician 2013;16(3):191– 98. PMID: 23703418.33. Makhlouf T., Emil N.S., Sibbitt W.L. Jr et al. Outcomes and cost-effectiveness of carpal tunnel injections using sonographic needle guidance. Clin Rheumatol 2014;33(6):849–58. DOI: 10.1007/ s10067-013-2438-5. PMID: 24277115.Makhlouf T., Emil N.S., Sibbitt W.L. Jr et al. Outcomes and cost-effectiveness of carpal tunnel injections using sonographic needle guidance. Clin Rheumatol 2014;33(6):849–58. DOI: 10.1007/ s10067-013-2438-5. PMID: 24277115.34. Chen P.C., Chuang C.H., Tu Y.K. et al. A Bayesian network meta-analysis: comparing the clinical effectiveness of local corticosteroid injections using different treatment strategies for carpal tunnel syndrome. BMC Musculoskelet Disord 2015;16:363. DOI: 10.1186/s12891-015- 0815-8. PMID: 26585378.Chen P.C., Chuang C.H., Tu Y.K. et al. A Bayesian network meta-analysis: comparing the clinical effectiveness of local corticosteroid injections using different treatment strategies for carpal tunnel syndrome. BMC Musculoskelet Disord 2015;16:363. DOI: 10.1186/s12891-015- 0815-8. PMID: 26585378.35. Richmond D.A. Carpal tunnel syndrome. Br Med J 1958;1:773–4. DOI: 10.1136/ bmj.1.5073.773-c.Richmond D.A. Carpal tunnel syndrome. Br Med J 1958;1:773–4. DOI: 10.1136/ bmj.1.5073.773-c.36. Foster J.B. Hydrocortisone and the carpal tunnel syndrome. Lancet 1960;275(7122):454–56. DOI: 10.1016/ s0140-6736(60)90389-5.Foster J.B. Hydrocortisone and the carpal tunnel syndrome. Lancet 1960;275(7122):454–56. DOI: 10.1016/ s0140-6736(60)90389-5.37. Kendall P.H. Carpal tunnel syndrome. BMJ 1962;1(5271):115. DOI: 10.1136/ bmj.1.5271.115. PMID: 14455115.Kendall P.H. Carpal tunnel syndrome. BMJ 1962;1(5271):115. DOI: 10.1136/ bmj.1.5271.115. PMID: 14455115.38. Girlanda P., Dattola R., Venuto C. et al. Local steroid treatment in idiopathic carpal tunnel syndrome: short and long-term efficacy. J Neurol 1993;240(3):187–90. DOI: 10.1007/BF00857526. PMID: 8482993.Girlanda P., Dattola R., Venuto C. et al. Local steroid treatment in idiopathic carpal tunnel syndrome: short and long-term efficacy. J Neurol 1993;240(3):187–90. DOI: 10.1007/BF00857526. PMID: 8482993.39. Armstrong T., Devor W., Borschel L., Contreras R. Intracarpal steroid injection is safe and effective for short-term management of carpal tunnel syndrome. Muscle Nerve 2004;29(1):82–8. DOI: 10.1002/mus.10512. PMID: 14694502.Armstrong T., Devor W., Borschel L., Contreras R. Intracarpal steroid injection is safe and effective for short-term management of carpal tunnel syndrome. Muscle Nerve 2004;29(1):82–8. DOI: 10.1002/mus.10512. PMID: 14694502.40. Visser L.H., Ngo Q., Groeneweg S.J., Brekelmans G. Long term effect of local corticosteroid injection for carpal tunnel syndrome: a relation with electrodiagnostic severity. Clin Neurophysiol 2012;123(4):838–41. DOI: 10.1016/j. clinph.2011.08.022. PMID: 21962473.Visser L.H., Ngo Q., Groeneweg S.J., Brekelmans G. Long term effect of local corticosteroid injection for carpal tunnel syndrome: a relation with electrodiagnostic severity. Clin Neurophysiol 2012;123(4):838–41. DOI: 10.1016/j. clinph.2011.08.022. PMID: 21962473.41. Evers S., Bryan A.J., Sanders T.L. et al. Corticosteroid injections for carpal tunnel syndrome. Plast Reconstr Surg 2017;140(2):338–47. DOI: 10.1097/ PRS.0000000000003511. PMID: 28746281.Evers S., Bryan A.J., Sanders T.L. et al. Corticosteroid injections for carpal tunnel syndrome. Plast Reconstr Surg 2017;140(2):338–47. DOI: 10.1097/ PRS.0000000000003511. PMID: 28746281.42. Hagebeuk E.E., de Weerd A.W. Clinical and electrophysiological follow-up after local steroid injection in the carpal tunnel syndrome. Clinical Neurophysiology 2004;115(6):1464–8. DOI: 10.1016/j. clinph.2004.01.005. PMID: 15134716.Hagebeuk E.E., de Weerd A.W. Clinical and electrophysiological follow-up after local steroid injection in the carpal tunnel syndrome. Clinical Neurophysiology 2004;115(6):1464–8. DOI: 10.1016/j. clinph.2004.01.005. PMID: 15134716.43. Ozdogan H., Yazici H. The efficacy of local steroid injections in idiopathic carpal tunnel syndrome: a double blind study. Br J Rheumatol 1984;23(4):272–5. DOI: 10.1093/rheumatology/23.4.272. PMID: 6487932.Ozdogan H., Yazici H. The efficacy of local steroid injections in idiopathic carpal tunnel syndrome: a double blind study. Br J Rheumatol 1984;23(4):272–5. DOI: 10.1093/rheumatology/23.4.272. PMID: 6487932.44. Phalen G.S. The carpal tunnel syndrome. Seventeen years’ experience in diagnosis and treatment of six hundred fifty-four hands. J Bone Joint Surg Am 1966;48(2):211–28. DOI: 10.2106/00004623-196648020-00001. PMID: 5934271.Phalen G.S. The carpal tunnel syndrome. Seventeen years’ experience in diagnosis and treatment of six hundred fifty-four hands. J Bone Joint Surg Am 1966;48(2):211–28. DOI: 10.2106/00004623-196648020-00001. PMID: 5934271.45. Atroshi I., Flondell M., Hofer M., Ranstam J. Methylprednisolone injections for the carpal tunnel syndrome: a randomized, placebo-controlled trial. Ann Intern Med 2013;159(5):309–17. DOI: 10.7326/0003-4819-159-5- 201309030-00004. PMID: 24026316.Atroshi I., Flondell M., Hofer M., Ranstam J. Methylprednisolone injections for the carpal tunnel syndrome: a randomized, placebo-controlled trial. Ann Intern Med 2013;159(5):309–17. DOI: 10.7326/0003-4819-159-5- 201309030-00004. PMID: 24026316.46. O’Gradaigh D., Merry P. Corticosteroid injection for the treatment of carpal tunnel syndrome. Ann Rheum Dis 2000;59(11):918–9. DOI: 10.1136/ ard.59.11.918. PMID: 11053073.O’Gradaigh D., Merry P. Corticosteroid injection for the treatment of carpal tunnel syndrome. Ann Rheum Dis 2000;59(11):918–9. DOI: 10.1136/ ard.59.11.918. PMID: 11053073.47. Karadas O., Tok F., Ulaş U.H., Odabaşi Z. The effectiveness of triamcinolone acetonide vs. procaine hydrochloride injection in the management of carpal tunnel syndrome: a double-blind randomized clinical trial. Am J Phys Med Rehabil 2011;90(4):287–92. DOI: 10.1097/ PHM.0b013e31820639ec. PMID: 1273900.Karadas O., Tok F., Ulaş U.H., Odabaşi Z. The effectiveness of triamcinolone acetonide vs. procaine hydrochloride injection in the management of carpal tunnel syndrome: a double-blind randomized clinical trial. Am J Phys Med Rehabil 2011;90(4):287–92. DOI: 10.1097/ PHM.0b013e31820639ec. PMID: 1273900.48. Karadas O., Tok F., Akarsu S. et al. Triamcinolone acetonide vs procaine hydrochloride injection in the management of carpal tunnel syndrome: randomized placebocontrolled study. J Rehabil Med 2012;44(7): 601–4. DOI: 10.2340/16501977-0990. PMID: 22674243.Karadas O., Tok F., Akarsu S. et al. Triamcinolone acetonide vs procaine hydrochloride injection in the management of carpal tunnel syndrome: randomized placebocontrolled study. J Rehabil Med 2012;44(7): 601–4. DOI: 10.2340/16501977-0990. PMID: 22674243.49. Dernek B., Aydin T., Koseoglu P.K. et al. Comparison of the efficacy of lidocaine and betamethasone dipropionate in carpal tunnel syndrome injection. J Back Musculoskelet Rehabil 2017;30(3):435–40. DOI 10.3233/BMR-150477. PMID 28035909.Dernek B., Aydin T., Koseoglu P.K. et al. Comparison of the efficacy of lidocaine and betamethasone dipropionate in carpal tunnel syndrome injection. J Back Musculoskelet Rehabil 2017;30(3):435–40. DOI 10.3233/BMR-150477. PMID 28035909.50. Hui A.C., Wong S., Leung C.H. et al. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. Neurology 2005;64(12):2074–8. DOI: 10.1212/01.WNL.0000169017.79374.93. PMID: 15985575.Hui A.C., Wong S., Leung C.H. et al. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. Neurology 2005;64(12):2074–8. DOI: 10.1212/01.WNL.0000169017.79374.93. PMID: 15985575.51. Ly-Pen D., Andreu J.L., Millan I. et al. Comparison of surgical decompression and local steroid injection in the treatment of carpal tunnel syndrome: 2-year clinical results from a randomized trial. Rheumatology 2012;51(8):1447–54.DOI: 10.1093/ rheumatology/kes053. PMID: 22467087.Ly-Pen D., Andreu J.L., Millan I. et al. Comparison of surgical decompression and local steroid injection in the treatment of carpal tunnel syndrome: 2-year clinical results from a randomized trial. Rheumatology 2012;51(8):1447–54.DOI: 10.1093/ rheumatology/kes053. PMID: 22467087.52. Andreu J.L., Ly-Pen D., Millan I. et al. Local injection versus surgery in carpal tunnel syndrome: neurophysiologic outcomes of a randomized clinical trial. Clin Neurophysiol 2014;125(7):1479–84. DOI: 10.1016/j.clinph.2013.11.010. PMID: 24321619.Andreu J.L., Ly-Pen D., Millan I. et al. Local injection versus surgery in carpal tunnel syndrome: neurophysiologic outcomes of a randomized clinical trial. Clin Neurophysiol 2014;125(7):1479–84. DOI: 10.1016/j.clinph.2013.11.010. PMID: 24321619.53. Green D.P. Diagnostic and therapeutic value of carpal tunnel injection. J Hand Surg Am 1984;9(6):850–4. DOI: 10.1016/ s0363-5023(84)80065-9. PMID: 6512200.Green D.P. Diagnostic and therapeutic value of carpal tunnel injection. J Hand Surg Am 1984;9(6):850–4. DOI: 10.1016/ s0363-5023(84)80065-9. PMID: 6512200.