University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Physical Medicine and Rehabilitation


Dr. Laura Witte


Background/Objective: A literary review was conducted to evaluate the efficacy of ultrasound-guided carpal tunnel corticosteroid injections versus landmark-guided injections in the treatment of carpal tunnel syndrome (CTS) and help determine the best procedure approach to improve clinical outcomes.

Methods: A PubMed literature search was conducted with the search terms “carpal tunnel syndrome” and “ultrasound-guided injection.” The search retrieved 62 articles. Title and abstract were reviewed to select pertinent articles. Priority was given to randomized-controlled trials (RCTs), systematic reviews, and meta-analyses published from 2015 to 2020 comparing the effectiveness of ultrasound-guided carpal tunnel injections versus landmark-guided injections. Other articles reviewed were found within the references of those articles.

Results: Landmark and ultrasound-guided carpal tunnel injections lowered CTS symptom severity. Ultrasound-guided carpal tunnel injections were superior to landmark-guided injections in reducing symptom severity. Evidence suggests there is superior efficacy and safety with ultrasound-guided carpal tunnel injections compared to landmark-guided injections. Few studies showed equivocal benefit between landmark and ultrasound-guided carpal tunnel injections. Ultrasound-guided carpal tunnel injections demonstrate significant improvement in lowering the rate of patients progressing to carpal tunnel release surgery compared to landmark-guided injections.

Conclusions: This review suggests that trained clinicians should pursue the ultrasound-guided approach to carpal tunnel injections when possible, due to evidence of increased efficacy and safety and decreased need to progress to carpal tunnel release surgery.

Keywords: Carpal tunnel syndrome, corticosteroid injection, CTS, ultrasound-guided injection, efficacy, carpal tunnel injection, landmark-guided injection


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