الفهرس 
ANATOMY OF CARPAL TUNNELOnly 14 pages are availabe for public view
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Abstract
This study was carried out to determine the effectiveness of perineural injection of dextrose 5 % buffered with sodium bicarbonate subcutaneously in treating patients with mild to moderate CTS.
It was a prospective randomized study that performed on twenty cases with idiopathic CTS; they were diagnosed clinically and electrophysiologically according to AANEM criteria (2002).
The exclusion criteria included patients with bleeding disorders, pregnancy & lactation and those receiving Oral contraceptive pills or any hormonal replacement treatment. Also cervical radiculopathy, polyneuropathy, brachial plexopathy, diabetes mellitus, thyroid problems, thoracic outlet syndrome, surgical treatment or any interventional treatment and malignant disorders were excluded.
All patients were subjected to full history taking, clinical examination with particular attention to provocative tests (Tinel, Phalen and Reverse phalen tests), laboratory and radiological investigations.
Clinical assessment scales was done in the form of VAS (0-10cm), BCTQ (SSS and FSS). Also, motor and sensory NCS including (distal latency, amplitude and conduction velocity) of median and ulnar nerves, F wave and mid palmar study was done for median nerve.
All patients received PIT sessions, the injection was done once weekly for 6 sessions with dextrose 5%(500ml) buffered with 2.4 ml sodium bicarbonate (8.4%concentration) each session was 5- 10 ml subcutaneously with insulin syringe with angle of introduction 30-40 around the lower superficial part of median nerve medial to the PL tendon with ½ to 1 ml of the solution per injection point.
Patients were assessed before and 6 weeks after receiving treatment sessions. Assessment included clinical examination, provocative tests, clinical assessment scales and nerve conduction studies.
Statistical analysis of the results was done.
Results: Our twenty cases were 16 females and 4 males; they were in the middle age ranged from 23 to 55 years.
Results revealed that there was a highly significant statistically difference according to sensory examination after receiving treatment, but as regard motor examination, there was no significant statistically difference.
Regarding provocative tests (Tinel test, phalen test and reverse phalen test) and the clinical scales (VAS, SSS, and FSS) there was a highly statistical significant difference after receiving treatment.
Our results as regard Nerve conduction studies of DML, sensory CV and DSL –difference between median and ulnar nerves showed that there was a statistical significant difference with improvement and there was a highly statistical significant difference with improvement as regard DSL and DML-difference between median and ulnar nerves.
By correlation with clinical assessment scales before and after treatment, it found that there was no correlation with age and disease duration.
The correlation with parameters of NCS showed a negative correlation between age and motor amplitude, also between disease duration and each of the following, sensory amplitude and sensory conduction velocity.
In addition, by studying correlation between the parameters of NCS and the clinical assessment scales before treatment, it found that there were positive correlations between SSS and DSL as well as between VAS and DML and a negative correlation between VAS and motor conduction velocity, sensory conduction velocity.
After treatment, there were a negative correlation between VAS and motor conduction velocity, sensory conduction velocity.