Background & Aims

Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. Recently, hydrodissection or perineural injection and percutaneous flexor retinaculum release have been increasingly used to treat CTS using ultrasound or anatomical surface landmark guiding. Different injectates are available with their safety and effectiveness being continuously investigated. Five percent dextrose in water (D5W) is a widely used agent due to its ability to reduce inflammation and lower the risk of nerve injury. This mini systematic review aims to integrate the evidence and effectiveness of hydrodissection using D5W to treat CTS.

Methods

Five databases including PubMed, Scopus, Cochrane Library, ProQuest, and EBSCO Medline were systematically searched up to January 4th, 2024. Studies evaluating the effectiveness of commonly used injectates including D5W for hydrodissection in CTS treatment were included. Outcomes were reported as pain scale, function and severity scale using Boston Carpal Tunnel Questionnaire (BCTQ) scale, sensory nerve conduction velocity (SNCV), distal motor latency (DML), cross-sectional area (CSA), sensory peak latency (SPL), compound muscle action potential (CMAP), and sensory nerve action potential (SNAP).

Results

From 6 studies, 313 wrists were included comparing D5W to 4 other agents (normal saline [NS], triamcinolone, platelet-rich plasma [PRP], and hyaluronic acid). D5W was superior to NS and hyaluronic acid in terms of clinical effectiveness. Both D5W and PRP showed consistently favorable outcomes. Compared to triamcinolone, only 1 out of 3 studies showed significant improvement by D5W in pain scale by visual analog scale and severity by BCTQ. None of the reviewed studies reported any adverse event.

Conclusions

Hydrodissection with D5W provides clinical benefits and is effective in treating CTS. More studies investigating the efficacy of D5W in CTS are needed.

References

Wu YT, Ho TY, Chou YC, Ke MJ, Li TY, Tsai CK, Chen LC. Six-month efficacy of perineural dextrose for carpal tunnel syndrome: a prospective, randomized, double-blind, controlled trial. InMayo Clinic Proceedings 2017 Aug 1 (Vol. 92, No. 8, pp. 1179-1189). Elsevier.
Wu YT, Ke MJ, Ho TY, Li TY, Shen YP, Chen LC. Randomized double?blinded clinical trial of 5% dextrose versus triamcinolone injection for carpal tunnel syndrome patients. Annals of neurology. 2018 Oct;84(4):601-10.
Shen YP, Li TY, Chou YC, Ho TY, Ke MJ, Chen LC, Wu YT. Comparison of perineural platelet?rich plasma and dextrose injections for moderate carpal tunnel syndrome: a prospective randomized, single?blind, head?to?head comparative trial. Journal of tissue engineering and regenerative medicine. 2019 Nov;13(11):2009-17.
Aghaei S, Khosrawi S, Hoseini SG, Khosravi M, Maghroori R. Local Injection of 5% Dextrose Versus Triamcinolone in Carpal Tunnel Syndrome: a Randomized Clinical Trial. SN Comprehensive Clinical Medicine. 2021 Dec 29;4(1):4.
Santoso WM, Sasono IS, Setianto CA, Hevy N. COMPARISON OF HYDRODISSECTION INJECTION THERAPY USING ULTRASONOGRAPHIC AS GUIDES BETWEEN TRIAMCINOLONE ACETONIDE AND 5% DEXTROSE IN CARPAL TUNNEL SYNDROME. Journal of Pain, Headache and Vertigo. 2022 Jun 30;3(2):50-8.
Wu YT, Lam KH, Lai CY, Chen SR, Shen YP, Su YC, Li TY, Wu CH. Novel motor-sparing ultrasound-guided neural injection in severe carpal tunnel syndrome: a comparison of four injectates. BioMed Research International. 2022 Feb 17;2022

Presenting Author

Natasha Yang

Poster Authors

Natasha Yang

MD

Bethesda Hospital, Yogyakarta, Indonesia

Lead Author

Yohan Budi Hartanto

Bethesda Hospital, Yogyakarta, Indonesia

Lead Author

Topics

  • Treatment/Management: Interventional Therapies – Injections/Blocks