• Arash Babaei-Ghazani, Nadere Nikbakht, Bijan Forogh, Gholam Reza Raissi, Tannaz Ahadi, Safoora Ebadi, Peyman Roomizadeh, Hamid Reza Fadavi, Seyed Ahmad Raeissadat, and Bina Eftekharsadat.
• From the Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, Iran University of Medical Sciences, Tehran, Iran (AB-G, NN, BF, GRR, TA, SE, PR); Physical Medicine and Rehabilitation Specialist With Subspecialty in Interventional Pain Management, Mission Pain and Spine, Mission Viejo, California (HRF); Clinical Development Research Center of Shahid Modarres Hospital, Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (SAR); and Physical Medicine and Rehabilitation Research Center, Department of Physical Medicine and Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran (BE).
• Am J Phys Med Rehabil. 2018 Jun 1; 97 (6): 407-413.

ObjectiveIn this study, the clinical effectiveness of ultrasound-guided corticosteroid injection "above" versus "below" the median nerve for treatment of patients with mild to moderate carpal tunnel syndrome was compared.DesignThis prospective randomized double-blind clinical trial included 44 patients with mild to moderate carpal tunnel syndrome. The subjects were randomly assigned to two groups to receive ultrasound-guided injection of 40 mg of triamcinolone either "above" or "below" the involved median nerve. Outcome measures were the Boston Carpal Tunnel Questionnaire, visual analog scale, electrophysiological tests, and ultrasonographic measurement of the median nerve cross-sectional area at baseline, 6, and 12 wks after the injection.ResultsAll outcome measures improved significantly in both groups at 6 wks after intervention, and these improvements were persevered up to 12 wks of follow-up (all P values <0.05). However, there was no significant difference in measured outcomes between the two groups. No adverse effects were observed.ConclusionsBoth above and under median nerve ultrasound-guided steroid injection techniques were effective in reducing the symptoms, improving the function, and improving electrodiagnostic and sonographic findings of carpal tunnel syndrome. However, the amount of improvement in the outcomes did not differ between groups, implying that none of technique has the superiority over another.

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