J Ayub Med Coll Abbottabad 2015;27(1) http://www.ayubmed.edu.pk/JAMC/27-1/Saboor.pdf 192 ORIGINAL ARTICLE EARLY RESPONSE OF LOCAL STEROID INJECTION VERSUS MINI INCISION TECHNIQUE IN TREATMENT OF CARPAL TUNNEL SYNDROME Abdus Saboor Awan, Alamzeb Khan, Sikandar Aziz Afridi*, Inam Ullah Khan, Sajid Nazir Bhatti**, Ehtisham Ahmed**, Gul Muhammad**, Rao Suhail Khan***, Shahid Sultan, Fahad Saqib Lodhi † Department of Orthopedics, *Department of Surgery, **Department of Neurosurgery, Ayub Medical College, Abbottabad (AMC), Abbottabad, ***Department of Neurology, PIMS, Islamabad, † Department of Community Medicine, Abbottabad International Medical College, Abbottabad-Pakistan Background: Carpal tunnel syndrome (CTS) is one of the commonest peripheral neuropathies which effects mainly middle aged women. Different techniques are being tried to decrease the post- operative pain in patients operated for CTS. The objective of this study was to compare effectiveness of local injection of steroid and mini incision technique in the treatment of carpal tunnel syndrome. Methods: This randomized control trial was conducted at department of Orthopedics and department of Neurosurgery, Ayub Teaching Hospital, Abbottabad from Aug 2011 to Feb 2013. A total of 116 patients of CTS were randomly allocated to either of the two groups. Fifty-eight Patient in Group A were subjected to local steroid injection and the same number of patient in Group B underwent mini incision technique. All patients of were advised to report to the OPD after one month to determine intervention effectiveness in terms of improvement in at least one grade of pain. Results: In this study mean age of the patients was 32.8±5.1 years. Female gender was in dominance with 99 (86.3%) cases. In this study we compared the effectiveness of local steroid injection and mini incision technique in the treatment of carpel tunnel syndrome. We found out that the steroid injection was effective in 69.0% cases while mini incision technique was effective in 56.9% cases. The difference being statistically insignificant with a p-value of 0.17. Conclusion: The difference in pain after 1 month of the intervention was not statistically significant. Keywords: Carpal tunnel syndrome, neuropathy, nerve compression syndromes J Ayub Med Coll Abbottabad 2015;27(1):192–6 INTRODUCTION Carpal tunnel syndrome (CTS) is a common neuropathy caused by the compression of median nerve at the level of wrist and is estimated to occur in 4% of the general population. Higher prevalence is reported in women (3% to 5.6%) than men (0.6– 2.8%). 1 In half of the cases the exact cause of compression is unknown (idiopathic). However, different medical conditions like diabetes mellitus, thyroid disease, rheumatoid arthritis, pregnancy, trauma etc. 2 The classic symptoms include nocturnal pain associated with tingling and numbness in the distribution of median nerve in the hand. 2 Different clinical signs used to diagnose CTS include Tinel sign, Phalen test and Durans test help in the diagnosis. But none of these tests are diagnostic on their own. 2 Median nerve conduction studies are the gold standard diagnostic tests. The sensitivity of nerve conduction studies ranges from 49% to 84% and specificity ranges from 95% to 99%. The diagnosis of CTS should be based on history, physical examination and results of electrophysiological studies. 2 Treatment modalities for CTS include physiotherapy, non-steroidal anti-inflammatory drugs (NSAIDs), steroid injection and various surgical options 3 , like conventional open technique with long palmar curvilinear incision (consists of making an incision up to 2 inches in the wrist) 4 , minimal incision (1.5–2 cm mid palmar incision) and endoscopic carpal tunnel release. 5,6 The endoscopic carpal tunnel release is a reliable method in the treatment of idiopathic carpal tunnel syndrome. And it has the advantages of slight scar tenderness, less operation time, less in hospital stay, early functional recovery, safety, and high- satisfaction rate compared with open method. 1,7 Traditional open carpal tunnel release (OCTR) is the gold standard for the surgical treatment of carpal tunnel syndrome. This procedure provides direct vision and access to the ligament. This in turn gives a better chance for complete section of the ligament and allows treatment of any co-existant pathology associated with or contributing to symptoms of carpal tunnel syndrome. Its main drawbacks of this procedure being are tender scar, healing period pillar pain, reflex sympathetic dystrophy long, flexor tendon bowstringing, adherence of tendons, and cosmetic complaints. All these symptoms are related to the incision itself. 8 To obviate these potential complications mini open technique is used, which is simple, safe, cosmetically satisfactory and cost