Comparing the efficacy of ultrasound-guided versus anatomical localization for corticosteroid injection in the treatment of carpal tunnel syndrome: A systematic review and meta-analysis

Abstract

Background: Carpal tunnel syndrome (CTS) remains a pervasive condition, often resulting in functional impairment and pain. There has been growing interest in refining treatment modalities to improve patient outcomes. This study examines whether ultrasound guidance enhances the efficacy and safety of corticosteroid injections for CTS compared to traditional injections based on anatomical landmarks.

Methods: This meta-analysis was conducted in strict accordance with the PRISMA guidelines. We employed the patient, intervention, comparison, outcome (PICO) framework to establish a comprehensive search strategy across several databases, with no language restrictions. Inclusion and exclusion criteria were meticulously defined to ensure the relevance and quality of the data. Independent reviewers conducted a rigorous selection and quality assessment process, including sensitivity analyses and publication bias evaluation, to synthesize the available evidence. Data analysis was meticulously carried out using Stata software, version 17 (StataCorp LLC, College Station).

Results: Six studies were included after a thorough search and selection process. Ultrasound-guided interventions significantly reduced Boston Carpal Tunnel Questionnaire symptom severity scores [SMD = -0.77, confidence interval (CI): -1.02 to -0.52, P < .01] and improved functional status scores (SMD = -0.36, CI: -0.60 to -0.12, P < .01) compared to the anatomical localization. Additionally, the incidence of nerve injury was lower in the ultrasound group (OR = 0.18, CI: 0.06 to 0.55, P < .01). Sensitivity analysis confirmed the robustness of these findings, and no publication bias was detected.

Conclusions: Ultrasound-guided corticosteroid injections provide significant improvements in symptom severity and functional outcomes for CTS patients, with a safer profile regarding nerve injury. These findings support the clinical preference for ultrasound guidance, with further validation needed from larger-scale trials.

Keywords: carpal tunnel syndrome; corticosteroid; injection techniques; meta-analysis; ultrasound.