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Ultrasound-Guided Needle Release Combined with Corticosteroid Injection for the Treatment of Supinator Syndrome
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Sonographically guided hydrodissection and corticosteroid injection for scleroderma hand.

Suzanne L DeLea1, Natalia R Chavez-Chiang, Janet L Poole

  • 1Division of Rheumatology, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA.

Clinical Rheumatology
|January 15, 2011
PubMed
Summary

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Hydrodissection with corticosteroid injection effectively reduced hand pain in scleroderma patients by 67%. This innovative treatment also improved vasomotor symptoms, offering significant relief for intractable pain.

Area of Science:

  • Rheumatology
  • Pain Management
  • Musculoskeletal Disorders

Background:

  • Scleroderma often causes severe hand pain due to vasospasm, digital ischemia, tenosynovitis, and nerve entrapment.
  • Current treatments for painful scleroderma hands can be limited, necessitating novel therapeutic approaches.

Purpose of the Study:

  • To investigate the efficacy of sonographically guided carpal tunnel hydrodissection followed by corticosteroid injection for managing painful scleroderma hands.
  • To compare outcomes in scleroderma patients with those having rheumatoid arthritis and carpal tunnel syndrome (RA/CTS).

Main Methods:

  • Twenty-six patients (12 scleroderma, 14 RA/CTS) underwent carpal tunnel hydrodissection with lidocaine.
  • Following hydrodissection, triamcinolone acetonide was injected into the carpal tunnel.

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  • Pain scores, procedural pain, responder rates, therapeutic duration, and reinjection intervals were assessed.

    • Main Results:

    • A significant reduction in pain scores was observed: 67% in scleroderma patients (p < 0.001) and 47% in RA/CTS patients (p < 0.001).
    • Scleroderma patients experienced longer intervals until the next injection (8.5 months vs. 5.2 months, p=0.03).
    • 83% of all subjects reported reduced Raynaud's attacks and healing of digital ulcers, with no reported complications.

    Conclusions:

    • Carpal tunnel hydrodissection with corticosteroid injection is a safe and effective treatment for reducing pain and vasomotor changes in the scleroderma hand.
    • The mechanism likely involves mechanical freeing of entrapped structures and corticosteroid-induced reduction of inflammation and vasospasm.
    • This procedure offers a promising therapeutic option for patients suffering from debilitating hand pain associated with scleroderma.