From mild to severe carpal tunnel syndrome: The role of ultrasound-guided perineural 5% dextrose injection: A prospective study

BackgroundUltrasound-guided perineural injection of 5% dextrose in water (D5W) is considered a safe treatment option associated with clinical improvement in patients with mild-to-moderate carpal tunnel syndrome (CTS).ObjectiveThis study aimed to evaluate the efficacy of ultrasound-guided D5 W injection in patients with varying severities of CTS, including mild, moderate and severe cases.Methods36 patients with electrophysiologically confirmed CTS (mild, n = 11; moderate, n = 13; severe, n = 12) received a single ultrasound-guided perineural injection of 5 mL D5W. Patients with severe CTS were included only if surgical treatment was declined or not feasible. Pain, neuropathic pain, symptoms and functional outcomes were assessed using the Visual Analogue Scale (VAS), Douleur Neuropathique en 4 Questions (DN4), and Boston Carpal Tunnel Questionnaire (BCTQ: Symptom Severity Scale [SSS], Functional Status Scale [FSS]) at baseline and weeks 1, 4, 12, and 24.ResultsAll three groups demonstrated significant within-group improvements in VAS, DN4, SSS, and FSS scores from baseline, with improvements evident by week 1 and maintained throughout the 24-week follow-up period (p < 0.001). Between-group comparisons showed better outcomes in mild and moderate CTS, whereas the severe group achieved significant improvements but with higher outcome scores (p < 0.05). No major adverse events, including hematoma, nerve injury or tendon rupture were observed during follow-up; however, mild and transient injection-site pain was reported in most patients.ConclusionThis study suggests that ultrasound-guided perineural D5W injection is associated with clinically meaningful improvements in pain, symptoms and function in patients with CTS across different severity levels, with less favorable outcomes in severe cases. This treatment may be considered a nonsurgical option for selected patients in whom surgical management is declined or not feasible.