• Abdelraheem Elawamy, Manal Hassanien, Ahmed Hamed, Al Shimaa Ismael Roushdy, Nisreen Adel Abass, Ghada Mohammed, Mohamed Raouf Abdel Razek Hasan, and Emad Zarief Kamel.
• Department of Anesthesia and Intensive Care, Faculty of Medicine, Assuit University, Assiut, Egypt.
• Pain Physician. 2020 Mar 1; 23 (2): E175-E183.

BackgroundCarpal tunnel syndrome (CTS) is the most common entrapment neuropathy, which results from median nerve compression. A lot of nonsurgical modalities are available for the management of mild to moderate situations. Local Hyalase hydrodissection (HD) of the entrapped median nerve could offer a desirable sustained symptom alleviation.ObjectivesTo evaluate the clinical efficacy of Hyalase/saline solution carpal tunnel HD on pain, functional status, and nerve conduction in patients with CTS.Study DesignA randomized, double-blinded trial.SettingAnesthesia, pain, and rheumatology clinics in a university hospital.MethodsPatients: 60 patients with CTS (> 6 months' duration).Interventionpatients were allocated equally into either group 1 (HD with Hyalase + 10 mL saline solution injection), or group 2 (HD with 10 mL saline solution only).Measurementsassessment of pain using Visual Analog Scale (VAS), functional disability (FD) score, and nerve conduction studies before injection, and over 6 months after injection. Nerve conduction parameters before injection and postinjection by the end of 3 and 6 months were evaluated as well.ResultsStatistically significant lower postinjection values of VAS (1 ± 1.8, 2 ± 1.1, 2 ± 1.2, 2 ± 1.1) in group 1 versus (2 ± 1.2, 3 ± 1.7, 4 ± 1.5, 5 ± 2.6) in group 2 by the end of the first week, and the first, third, and sixth months, and significantly lower FD scores (15.3 ± 1.2, 13 ± 1.3, 10.2 ± 1.3, 10.2 ± 1.3) in group 1 versus (17.5 ± 1.8, 16.6 ± 2.8, 19.4 ± 3.2, 21.2 ± 2.5) in group 2 during the same time intervals. Nerve conduction study parameters have shown significantly higher velocity and lower latency in the Hyalase group than in the saline solution group by the 3 and 6 month follow-up.LimitationWe suggest a longer period could be reasonable.ConclusionsCarpal tunnel HD with Hyalase with saline solution is considered as an efficient technique offering a rapid onset of pain relief and functional improvements, and better median nerve conduction in patients with CTS over 6 months follow-up duration.Key WordsCarpal tunnel syndrome, Hyalase, median nerve hydrodissection.

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