This study compares the effectiveness of two types of local injections-Hyaluronic Acid (HA) and corticosteroids-for treating mild to moderate idiopathic Carpal Tunnel Syndrome (CTS). Sixty adult patients will be assigned to receive one of the two injections under ultrasound guidance. The goal is to see if HA is as effective as the standard corticosteroid treatment in improving symptoms and nerve function over a 3-month follow-up period.
Numbness or pain in the Median Nerve (MN) distribution.
Nerve conduction studies (NCS) consistent with CTS as per the AANEM guidelines.
An MN cross-sectional area (CSA) at the wrist >12 mm²
Patients with severe symptoms (indication for surgery).
Patients who show improvement on medical treatment.
Patients with previous surgical or injectional CTS treatment.
Coexistence of brachial plexopathy, or thoracic outlet syndrome.
Parallel
Low Molecular Weight Hyaluronic Acid
DrugUltrasound-guided perineural injection of low molecular weight Hyaluronic Acid.
corticosteroid
DrugUltrasound-guided perineural injection of corticosteroids
Change in Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) Scores
Comparison of the BCTQ scores (symptom severity and functional status) between the Hyaluronic Acid and Corticosteroid groups.
Change in Electro-diagnostic Parameters
Comparison of sensory and motor electrodiagnostic parameters between the two groups, including peak sensory latency (ms), sensory nerve action potential - SNAP (µV), sensory conduction velocity - SCV (m/s), distal motor latency (ms), compound muscle action potential - CMAP (mV), and motor conduction velocity - MCV (m/s).
Change in Neuromuscular Ultrasound Examination Parameters
Comparison of neuromuscular ultrasound parameters between the two groups, including the median nerve cross-sectional area (CSA) measured in mm², fascicular pattern, flattening ratio, and mobility of the median nerve.
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