Comparison of Ultrasound-guided Hydrodissection and Medical Therapy in Mild-to-Moderate Carpal Tunnel Syndrome: An Exploratory Study

Background: Ultrasound-guided hydrodissection (UGHD) of the median nerve within the carpal tunnel is an emerging treatment for mild-to-moderate carpal tunnel syndrome (CTS). There are no prospectively conducted studies in the Indian context. Therefore, we aimed to evaluate the effectiveness of UGHD of the median nerve using two readily available agents (triamcinolone and 5% dextrose [5% D]) and compare it with medical management (MM) in mild-to-moderate CTS. Methods: This prospective, exploratory study enrolled and randomized subjects into the MM (pregabalin alone), the 5% D (UGHD with 5 ml of 5% D), and the triamcinolone (UGHD with 5 ml of diluted triamcinolone) groups. Symptom severity (SSS) and functional severity (FSS) scores were assessed at baseline, 4 weeks, and 8 weeks. Nerve conduction study (NCS) and nerve cross-sectional area (CSA) at the inlet were measured at baseline and 8 weeks. Results: Seventy-five CTS hands from 49 subjects were included: MM (31), triamcinolone (21), and 5% D (23). The SSS improved at 4 weeks in all groups. While the score improved further beyond 4 weeks in MM, it remained static in both UGHD groups. The FSS improved in both UGHD groups at 4 weeks and remained unchanged at 8 weeks. Triamcinolone improved SSS more effectively than 5% D. Triamcinolone also improved NCS parameters and CSA. Conclusion: UGHD of the median nerve with either 5 ml of diluted triamcinolone or 5% D is a comparable and feasible treatment option for mild-to-moderate CTS. However, these results require validation in larger, adequately powered trials.