Carpal tunnel syndrome: selection of patients and assessment of the response to ecoguidated infiltration therapy with steroids of the median nerve by cSMI sampling.

Congress:

ECR 2018

Poster Number:

C-2023

Type:

Scientific Exhibit

Keywords:

Ultrasound, Extremities, Interventional non-vascular, Musculoskeletal system, Ultrasound-Power Doppler, Puncture, Inflammation

Authors:

A. Meli¹, V. Incarbone¹, C. Lupo², N. Casamassima³, L. Callegari¹; ¹Varese/IT, ²Palermo/IT, ³Varese , It/IT

DOI:

10.1594/ecr2018/C-2023

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-2023

Fig. 1: Widespread thickening and hypoechogenicity due to the interfascular edema of...

Fig. 2: Widespread thickening and hypoechogenicity due to the interfascular edema of...

Fig. 3: The Power-Doppler evaluation shows a marked increase in intraneural...

Fig. 4: Infiltration of methylprednisone peri-neural and sub-epineural, under...

Aims and objectives

To use cSMI sampling to select Patients with carpal tunnel syndrome, conditioning the presence of a neural floristic component, eligible for infiltrating steroid therapy and to evaluate about four weeks the response in terms of pain reduction, flogosis and of intraneural vascularization.

Methods and materials

From September 2015 to February 2016 we selected 15 Patients with clinical and electromyographic diagnosis of carpal tunnel syndrome. All Patients were subjected to a preliminary ultrasound examination (T0) that demonstrated: reduction of the median nerve echogenicity for edema with enhanced intraneural vascularization to cSMI sampling (Toshiba, Aplio 500) and nerve sharpening at carpal tunnel level. All Patients were re-evaluated clinically and ecographically at about 4 weeks after the procedure, with microvascularization re-evaluation by cSMI.

Results

Good clinical response, with an improvement of painful symptomatology reported variable from discreet to complete disappearance of pain. At sampling with cSMI we demonstrated in all cases a reduction of intraneural flogistic hypervascularisation. Furthermore, the magnitude of the clinical response was correlated to the reduction of intraneural vascularization.

Conclusion

The cSMI system seems to be extremely promising in the selection of patients with carpal tunnel syndrome candidates for infiltrating therapy. This methodical discriminates patients with acute inflammation from patients with fibrosis from chronic inflammation in which infiltrating therapy, does not yield satisfactory results in the medium to long term. It has also been shown to be effective in evaluating the response to treatment, which corresponds to the clinical response. Our target in the future is try to perform a long-term follow-up (6-12 months), to...

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References

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