RCT#1 Carpal tunnel treatment with D5W versus normal saline 2017
The first controlled and randomized clinical trial on hydrodissection using 5% dextrose in water (D5W) was published in Mayo Clinic Proceedings in 2017 by Wu et al.
Wu YT, Ho TY, Chou YC, et al. Six-month efficacy of perineural dextrose for carpal tunnel syndrome: A prospective, randomized, double-blind, controlled trial. Mayo Clin Proc. 2017;92(8):1179-1189.
This was a single injection study of participants with carpal tunnel syndrome, consisting of using ultrasound guidance to hydrodissect about the median nerve with either D5W or normal saline (saline). Pain improvements were more in the dexrose-treated group, and the swollen median nerve decreased in size and its electrical conduction properties improved. Here is that abstract.
ABSTRACT
OBJECTIVE: To assess the 6-month effectiveness of ultrasound-guided perineural injection therapy (PIT) using 5% dextrose (D5W) in patients with mild-to-moderate carpal tunnel syndrome (CTS).
PATIENTS AND METHODS: A prospective, randomized, placebo-controlled, and double-blind study was conducted between May 1, 2016, through March 30, 2017. A total of 49 participants diagnosed with mild-to-moderate CTS were randomized into D5W and control groups. Participants in the D5W group received 1 session of ultrasound-guided PIT with 5 cc of D5W, and the control group received PIT with normal saline. The visual analog scale measured pain as a primary outcome. Secondary outcomes were Boston Carpal Tunnel Syndrome Questionnaire scores, the cross-sectional area of the median nerve, and electrophysiological measurement results. Assessment was performed before injection and at 1, 3, and 6 months post-injection.
RESULTS: All patients (data from 30 wrists in each group) completed the study. Compared with the control group, at all post-injection time points, the D5W group had a significant reduction in pain and disability, improvement on electrophysiological response measures, and decreased cross-sectional area of the median nerve.
CONCLUSION: Our study reveals that ultrasound-guided PIT with D5W is an effective treatment for patients with mild-to-moderate CTS. TRIAL REGISTRATION: www.ClinicalTrials.gov: NCT02809261.
Wu YT, Ho TY, Chou YC, et al. Six-month efficacy of perineural dextrose for carpal tunnel syndrome: A prospective, randomized, double-blind, controlled trial. Mayo Clin Proc. 2017;92(8):1179-1189.
This was a single injection study of participants with carpal tunnel syndrome, consisting of using ultrasound guidance to hydrodissect about the median nerve with either D5W or normal saline (saline). Pain improvements were more in the dexrose-treated group, and the swollen median nerve decreased in size and its electrical conduction properties improved. Here is that abstract.
ABSTRACT
OBJECTIVE: To assess the 6-month effectiveness of ultrasound-guided perineural injection therapy (PIT) using 5% dextrose (D5W) in patients with mild-to-moderate carpal tunnel syndrome (CTS).
PATIENTS AND METHODS: A prospective, randomized, placebo-controlled, and double-blind study was conducted between May 1, 2016, through March 30, 2017. A total of 49 participants diagnosed with mild-to-moderate CTS were randomized into D5W and control groups. Participants in the D5W group received 1 session of ultrasound-guided PIT with 5 cc of D5W, and the control group received PIT with normal saline. The visual analog scale measured pain as a primary outcome. Secondary outcomes were Boston Carpal Tunnel Syndrome Questionnaire scores, the cross-sectional area of the median nerve, and electrophysiological measurement results. Assessment was performed before injection and at 1, 3, and 6 months post-injection.
RESULTS: All patients (data from 30 wrists in each group) completed the study. Compared with the control group, at all post-injection time points, the D5W group had a significant reduction in pain and disability, improvement on electrophysiological response measures, and decreased cross-sectional area of the median nerve.
CONCLUSION: Our study reveals that ultrasound-guided PIT with D5W is an effective treatment for patients with mild-to-moderate CTS. TRIAL REGISTRATION: www.ClinicalTrials.gov: NCT02809261.
RCT#2 Carpal tunnel treatment with D5W versus a steroid (triamcinolone acetonide) - 2018
The second randomized, blinded, and controlled trial on hydrodissection using 5% dextrose in water (D5W) was published in Annals of Neurology in 2018 by Wu et al.
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. Ann Neurol 2018;84:601-10.
This was also a single injection study of participants with carpal tunnel syndrome, consisting of using ultrasound guidance to hydrodissect about the median nerve with either D5W or a steroid (trimcinolone acetonide, a total of 30 mg), mixed with normal saline. Pain improvements were more in the dextrose-treated group, and the swollen median nerve decreased in size and its electrical conduction properties improved. Here is that abstract.
ABSTRACT
Objective: Perineural injection with 5% dextrose (D5W) is a novel strategy in the treatment of carpal tunnel syndrome (CTS). In contrast, perineural injection with corticosteroid has been used for decades for treating CTS, but possible neurotoxicity has been a major concern. No studies investigating the comparative effects have been published so far. The authors performed a prospective, randomized, double-blinded, head-to-head comparative trial to compare these two approaches for patients having mild-to-moderate CTS.
Methods: Fifty-four participants with mild-to-moderate CTS were randomly divided into dextrose and steroid groups. The patients were administered 1 session of perineural injection with 5ml D5W (dextrose group) or 3ml triamcinolone acetonide mixed with 2ml normal saline (steroid group), under ultrasound guidance. A visual analog scale was assigned to assess the primary outcome. The secondary outcomes were assessed using the Boston Carpal Tunnel Syndrome Questionnaire, cross-sectional area of the median nerve, and electrophysiological studies. The assessment was performed prior to injection and 1, 3, 4, and 6 months postinjection.
Results: All patients (27 wrists per group) completed the study. Compared with the steroid group, the dextrose group exhibited a significant reduction in pain and disability through the 4th to the 6th month (p < 0.01).
Interpretation: Our study demonstrates that perineural injection of D5W is more beneficial than that of corticosteroid in patients with mild-to-moderate CTS at 4 to 6 months postinjection. Ann Neurol 2018;84:601-610.
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. Ann Neurol 2018;84:601-10.
This was also a single injection study of participants with carpal tunnel syndrome, consisting of using ultrasound guidance to hydrodissect about the median nerve with either D5W or a steroid (trimcinolone acetonide, a total of 30 mg), mixed with normal saline. Pain improvements were more in the dextrose-treated group, and the swollen median nerve decreased in size and its electrical conduction properties improved. Here is that abstract.
ABSTRACT
Objective: Perineural injection with 5% dextrose (D5W) is a novel strategy in the treatment of carpal tunnel syndrome (CTS). In contrast, perineural injection with corticosteroid has been used for decades for treating CTS, but possible neurotoxicity has been a major concern. No studies investigating the comparative effects have been published so far. The authors performed a prospective, randomized, double-blinded, head-to-head comparative trial to compare these two approaches for patients having mild-to-moderate CTS.
Methods: Fifty-four participants with mild-to-moderate CTS were randomly divided into dextrose and steroid groups. The patients were administered 1 session of perineural injection with 5ml D5W (dextrose group) or 3ml triamcinolone acetonide mixed with 2ml normal saline (steroid group), under ultrasound guidance. A visual analog scale was assigned to assess the primary outcome. The secondary outcomes were assessed using the Boston Carpal Tunnel Syndrome Questionnaire, cross-sectional area of the median nerve, and electrophysiological studies. The assessment was performed prior to injection and 1, 3, 4, and 6 months postinjection.
Results: All patients (27 wrists per group) completed the study. Compared with the steroid group, the dextrose group exhibited a significant reduction in pain and disability through the 4th to the 6th month (p < 0.01).
Interpretation: Our study demonstrates that perineural injection of D5W is more beneficial than that of corticosteroid in patients with mild-to-moderate CTS at 4 to 6 months postinjection. Ann Neurol 2018;84:601-610.
RCT#3 Single injection of PRP versus single injection of D5W 2019
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. J Tissue Eng Regen Med. 2019 Nov;13(11):2009-2017. doi: 10.1002/term.2950. Epub 2019 Aug 20. PMID: 31368191.
This compared a single injection (only 3 mL) of PRP versus D5W for moderate carpal tunnel syndrome. PRP did better than dextrose in shrinking nerve swelling, but both helped symptoms. This is a small volume and Dr. Wu's group has indicated that larger volumes are better. This was not conducted with cost effectivness in mind, which will be a component useful to include in subsequent studies. Below is the abstract for Shen et al.
ABSTRACT
Recent studies demonstrated the utility of perineural injection with platelet-rich plasma (PRP) and 5% dextrose (D5W) as novel strategies for treatment of carpal tunnel syndrome (CTS). The present study comprised a prospective, randomized, single-blind, head-to head comparative trial to compare the 6-month outcome of perineural injection with PRP or D5W in patients with moderate CTS. Fifty-two patients with unilateral moderate CTS were enrolled and randomized into two groups: The PRP group received a single 3-cc perineural injection of PRP under ultrasound guidance, and dextrose group received a single 3-cc perineural injection of D5W under ultrasound guidance. The Boston Carpal Tunnel Syndrome Questionnaire score was used as the primary outcome. Secondary outcomes included cross-sectional area (CSA) of the median nerve and electrophysiological assessments. Evaluations were performed at baseline and at 1, 3, and 6 months postinjection. All patients (26 patients per group) completed the study. Compared with the dextrose group, the PRP group demonstrated significant reductions in Boston Carpal Tunnel Syndrome Questionnaire function at 3 months (p = .044), distal motor latency at 6 months (p = .028), and CSA at 3 and 6 months (p = .010 and.018, respectively). A single perineural injection of PRP reduced the CSA of the median nerve more effectively than injection of D5W at 3 and 6 months postinjection for patients with moderate CTS.
Recent studies demonstrated the utility of perineural injection with platelet-rich plasma (PRP) and 5% dextrose (D5W) as novel strategies for treatment of carpal tunnel syndrome (CTS). The present study comprised a prospective, randomized, single-blind, head-to head comparative trial to compare the 6-month outcome of perineural injection with PRP or D5W in patients with moderate CTS. Fifty-two patients with unilateral moderate CTS were enrolled and randomized into two groups: The PRP group received a single 3-cc perineural injection of PRP under ultrasound guidance, and dextrose group received a single 3-cc perineural injection of D5W under ultrasound guidance. The Boston Carpal Tunnel Syndrome Questionnaire score was used as the primary outcome. Secondary outcomes included cross-sectional area (CSA) of the median nerve and electrophysiological assessments. Evaluations were performed at baseline and at 1, 3, and 6 months postinjection. All patients (26 patients per group) completed the study. Compared with the dextrose group, the PRP group demonstrated significant reductions in Boston Carpal Tunnel Syndrome Questionnaire function at 3 months (p = .044), distal motor latency at 6 months (p = .028), and CSA at 3 and 6 months (p = .010 and.018, respectively). A single perineural injection of PRP reduced the CSA of the median nerve more effectively than injection of D5W at 3 and 6 months postinjection for patients with moderate CTS.
RCT#4 Single injection of D5W versus single injection of steroid 2022 with 1 year follow
Aghaei, S., Khosrawi, S., Hoseini, S.G. et al. Local Injection of 5% Dextrose Versus Triamcinolone in Carpal Tunnel Syndrome: a Randomized Clinical Trial. SN Compr. Clin. Med. 4, 4 (2022). https://doi.org/10.1007/s42399-021-01099-5
This study injected only once with a small volume (only 2 mL) of either D5W or triamcinolone. Despite the small volume, both treatments were effective to 1 year follow-0up, with clinically important benefit in the Boston Carpal Tunnel Questionnaire (both sub scores) but no difference was found between them. This was, however, A victory for dextrose since it has less relative side effects. Below is the abstract for Aghaei et al.
ABSTRACT
This study aimed to compare the long-term effectiveness of a single local injection of 5% dextrose water (5%DW) vs. steroid in CTS. This was a prospective randomized clinical trial with 1:1 allocation, which recruited patients with mild to moderate CTS. Patients received a local landmark-based injection of 5%DW or 40 mg triamcinolone acetonide (final volume of 2 ml in both groups). Boston Carpal Tunnel Questionnaire (BCTQ) score and the visual analog scale for pain and paresthesia were measured before and 1, 3, and 12 months after the intervention. The electrophysiological parameters were assessed before and 3 months after the intervention. A mixed model analysis of variance (ANOVA) was used to analyze the outcomes within and between groups. Forty patients enrolled in the study (mean age: 51 ± 8 years, male/female: 6/34). Both groups showed significant improvement in BCTQ scores and VAS at all follow-ups relative to the baseline (p < 0.001). The sensory and motor latencies showed improvement in both groups after 3 months (p < 0.05). However, there was no significant difference between groups at any time point for clinical or electrophysiological parameters. Post-injection pain was more likely to occur in the steroid group (75.0% vs. 10.0%, p < 0.001). Local injection of 5%DW and steroids have comparable long-term benefits for mild to moderate CTS (study protocol registration: IRCT20180209038673N4).
This study aimed to compare the long-term effectiveness of a single local injection of 5% dextrose water (5%DW) vs. steroid in CTS. This was a prospective randomized clinical trial with 1:1 allocation, which recruited patients with mild to moderate CTS. Patients received a local landmark-based injection of 5%DW or 40 mg triamcinolone acetonide (final volume of 2 ml in both groups). Boston Carpal Tunnel Questionnaire (BCTQ) score and the visual analog scale for pain and paresthesia were measured before and 1, 3, and 12 months after the intervention. The electrophysiological parameters were assessed before and 3 months after the intervention. A mixed model analysis of variance (ANOVA) was used to analyze the outcomes within and between groups. Forty patients enrolled in the study (mean age: 51 ± 8 years, male/female: 6/34). Both groups showed significant improvement in BCTQ scores and VAS at all follow-ups relative to the baseline (p < 0.001). The sensory and motor latencies showed improvement in both groups after 3 months (p < 0.05). However, there was no significant difference between groups at any time point for clinical or electrophysiological parameters. Post-injection pain was more likely to occur in the steroid group (75.0% vs. 10.0%, p < 0.001). Local injection of 5%DW and steroids have comparable long-term benefits for mild to moderate CTS (study protocol registration: IRCT20180209038673N4).
RCT#4 Single injection of D5W versus single injection of steroid 2022 with 6 month follow up.
Babaei-Ghazani A, Moradnia S, Azar M, Forogh B, Ahadi T, Chaibakhsh S, Khodabandeh M, Eftekharsadat B. Ultrasound-guided 5% dextrose prolotherapy versus corticosteroid injection in carpal tunnel syndrome: a randomized, controlled clinical trial. Pain Manag. 2022 Sep;12(6):687-697. doi: 10.2217/pmt-2022-0018. Epub 2022 Jul 18. PMID: 35848821.
Babaei-Ghazani et al also compared D5W hydrodissection to hydrodissection with a steroid (triamcinolone) but used 5 mL D5W versus 1 mL steroid solution and followed for 6 months. Once more dextrose shows at least comparable benefit while avoiding potential steroid side effects. Here is that abstract.
ABSTRACT
Aim: The main assessment of this study is to analyze the efficiency of ultrasound-guided dextrose
prolotherapy against corticosteroid injections for the treatment of carpal tunnel syndrome.
Materials & methods: A total of 54 patients with carpal tunnel syndrome were included. Patients who
were assigned into the prolotherapy group were injected with 5cc 5% dextrose water under
ultrasound guidance. Patients in the corticosteroid group received ultrasound-guided 1 ml triamcinolone
40 mg/ml injection.
Results: The inter-group analysis revealed that dextrose prolotherapy has a
similar efficacy as corticosteroid for improving pain intensity, functional limitation in daily life,
electrophysiologic parameters and ultrasonographic outcomes. No remarkable difference was found
between the two treatments until 3 months of follow-up.
Conclusion: Dextrose 5% has similar efficacy as triamcinolone for improving pain intensity, functional limitation in daily life, electrophysiologic parameters and ultrasonographic outcomes.
Aim: The main assessment of this study is to analyze the efficiency of ultrasound-guided dextrose
prolotherapy against corticosteroid injections for the treatment of carpal tunnel syndrome.
Materials & methods: A total of 54 patients with carpal tunnel syndrome were included. Patients who
were assigned into the prolotherapy group were injected with 5cc 5% dextrose water under
ultrasound guidance. Patients in the corticosteroid group received ultrasound-guided 1 ml triamcinolone
40 mg/ml injection.
Results: The inter-group analysis revealed that dextrose prolotherapy has a
similar efficacy as corticosteroid for improving pain intensity, functional limitation in daily life,
electrophysiologic parameters and ultrasonographic outcomes. No remarkable difference was found
between the two treatments until 3 months of follow-up.
Conclusion: Dextrose 5% has similar efficacy as triamcinolone for improving pain intensity, functional limitation in daily life, electrophysiologic parameters and ultrasonographic outcomes.