Dextrose, Corticosteroids and Surgical Release in Carpal Tunnel Syndrome
Dextrose, Corticosteroids and Surgical Release in Carpal Tunnel Syndrome
The objective of the present study is to compare the effectiveness of 5% dextrose, local
 corticosteroids injections and surgical release in patients with electrodiagnostically (EDx)
 mild to moderate carpal tunnel syndrome (CTS). The investigators hypothesize that in patients
 with mild to moderate CTS (1) local 5% dextrose injections is non-inferior to local
 corticosteroid injections at 12 months after treatment, and that (2) local 5% dextrose
 injections are of non-inferior effectiveness compared to surgical release at 6 months.
Surgical release of the carpal ligament is a standard treatment of the median nerve
 entrapment at the wrist. Local corticosteroid injections are also an established alternative,
 particularly for EDx mild or moderate CTS, although majority of patients still needs surgical
 decompression within 1 year. Majority of studies concluded that after more than 6 months of
 treatment surgical decompression is better than local corticosteroids injections.
 Furthermore, corticosteroids also have a number of side effects, including crystal induced
 synovitis, tendon rupture, axon and myelin degeneration, soft tissue atrophy, skin thinning,
 steroid flare and hot flushes. Therefore, it would be very useful to have an effective
 alternative substance for injections, without these problems. Perineural injection of
 dextrose also seems to be a promising treatment for entrapment neuropathies. To date only two
 studies investigated the effectiveness of 5% dextrose injections in patients with CTS.
 Authors concluded that this is an effective treatment, that is for patients with mild or
 moderate CTS even more beneficial than corticosteroid injections at 6 months follow-up. It
 was suggested that perineural injection of 5% dextrose decreases neurogenic inflammation. As
 5% dextrose has osmolarity similar to normal saline, this formulation seems particularly
 promising. These expectations were supported in studies including animals and humans
 reporting no harmful effects.
Inclusion Criteria (subject diagnosed as CTS if meeting criterion 1 + at least one of
 criteria 2 or 3):

 1. numbness and tingling in at least two out of the first four digits;

 2. symptoms exacerbated during the night or in the morning, on holding the objects or
 repetitive use of the hand;

 3. symptoms relieved by shaking the hand or reposition of the arm.

 In addition to these clinical criteria for recruitment EDx confirmation will also be
 needed. Only patients with bilateral EDx mild to moderate CTS will be included.

 Exclusion Criteria:

 1. polyneuropathy, symptoms of polyneuropathy, and all conditions causing polyneuropathy
 (e.g., diabetes);

 2. multiple mononeuropathy (e.g., hereditary neuropathy with liability to pressure
 palsies, syndrome Lewis Sumner);

 3. motor neuron disorders (e.g., monomelic amyotrophy, amyotrophic lateral sclerosis -
 ALS);

 4. brachial plexopathy;

 5. other focal neuropathies affecting upper limbs (e.g., other median neuropathies, ulnar
 neuropathies, thoracic outlet syndrome); or

 6. previous surgery or local injections for CTS.