Turkish Journal of Physical Medicine and Rehabilitation 2007 , Vol 53 , Num 2

Comparison of the Efficacy of Corticosteroid Injection, Night Splint and Physiotherapy in Diabetic Carpal Tunnel Syndrome

Şule Taşpınar 1 ,Füsun Şahin 2 ,Cem Erçalık 1 ,Banu KURAN 3 ,Kemal Barkut 4 ,Münevver Çelik 4 ,Sema Uçak 5 ,Yüksel Altunbaş 6
1 Şişli Etfal Eğitim ve Araştırma Hastanesi, Fizik Tedavi ve Rehabilitasyon Kliniği, İstanbul
2 Pamukkale Üniversitesi Tıp Fakültesi, Fizik Tedavi ve Rehabilitasyon Anabilim Dalı, Denizli, Türkiye
3 Clinic of Physical Medicine and Rehabilitation, Şişli Etfal Training and Research Hospital, İstanbul, Turkey
4 Şişli Etfal Eğitim ve Araştırma Hastanesi Nöroloji Kliniği, İstanbul
5 Şişli Etfal Eğitim ve Araştırma Hastanesi 2. Dahiliye Kliniği, İstanbul
6 Şişli Etfal Eğitim ve Araştırma Hastanesi, 2. Dahiliye Kliniği, İstanbul

Objectives: To evaluate the efficacy of physiotherapy, steroid injection, and night splint in diabetic carpal tunnel syndrome (CTS).

Materials and Methods: Total of 54 hands belonging to 35 diabetes mellitus patients admitted with complaints of paresthesias and pain, diagnosed electrophysiologically as CTS, were included in this prospective, single blinded, randomized study. Patients were randomized into three treatment groups: physiotherapy (US, TENS), night splint, steroid injection and evaluated before and 3 months after the treatment. Evaluated variables were 1) Pain (VAS), 2) Sensation evaluation (by monofilament, two-point discrimination test), 3) Muscle strength (grip and pinch), 4) Functional evaluation (Sollerman hand function test, Boston CTS questionnaire, Health Assessment Questionnaire), 5) electroneuromyography (EMG).

Results: Significant improvements were detected in all treatment groups in VAS, sensorial, motor and functional evaluations (p<0.05). EMG parameters (p<0.05), and VAS and HAQ scores improved markedly in steroid injection group (p<0.01). No significant changes were determined between the groups in terms of improvement rates before and after the treatment in all clinical and EMG parameters (p>0.05).

Conclusion: The fact that significant improvements were noted in clinical evaluation parameters in all groups, and that no method was superior over the other with respect to improvement rates suggest that all three methods might be used in the conservative treatment of diabetic CTS. However, corticosteroid injection might be preferred because of the significant improvement obtained in EMG. 

Keywords : Diabetes mellitus, diabetic, carpal tunnel syndrome, nerve conduction studies, functional evaluatio