1. 2020;23;E175-E183Efficacy of Hyalase Hydrodissection in the Treatment of Carpal Tunnel Syndrome: A Randomized, Double-Blind, Controlled, Clinical Trial
   Randomized Trial
   Mohamed Raouf Abdel Razek Hasan, MD, Ghada Mohammed, MD, Nisreen Adel Abass, MD, Al Shimaa Ismael Roushdy, MD, Ahmed Hamed, MD, Manal Hassanien, MD, Abdelraheem Elawamy, MD, and Emad Zarief Kamel, MD.

BACKGROUND: Carpal 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.

OBJECTIVES: To evaluate the clinical efficacy of Hyalase/saline solution carpal tunnel HD on pain, functional status, and nerve conduction in patients with CTS.

STUDY DESIGN: A randomized, double-blinded trial.

SETTING: Anesthesia, pain, and rheumatology clinics in a university hospital.

METHODS: Patients: 60 patients with CTS (> 6 months’ duration). Intervention: patients 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). Measurements: assessment 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.

RESULTS: Statistically 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.

LIMITATION: We suggest a longer period could be reasonable.

CONCLUSIONS: Carpal 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 WORDS: Carpal tunnel syndrome, Hyalase, median nerve hydrodissection