Comparison between the Effects of Insulin versus Corticosteroid Local Injections in Diabetic Patients with Carpal Tunnel Syndrome

Shalaby, Ahmed Ismail Ali; Abd El Hamid, Kalthom Mohamed; Emam, Ibrahim Abd Alsamie; Azzam, Adel Ibrahim; Zaki, Mohamed Ahmed

doi:10.21608/ejhm.2018.17793

Comparison between the Effects of Insulin versus Corticosteroid Local Injections in Diabetic Patients with Carpal Tunnel Syndrome

Document Type : Original Article

Authors

¹ Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Al- Azhar University, Cairo, Egypt

² Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

10.21608/ejhm.2018.17793

Abstract

Background: Carpal tunnel syndrome (CTS) is a medical condition due to compression of the median nerve as it travels through the wrist at the carpal tunnel. Carpal tunnel syndrome is the most commonly diagnosed and treated entrapment neuropathy and is a significant cause of morbidity. It is estimated to affect one out of ten people during their lifetime. Diabetic patients have a higher incidence with carpal tunnel syndrome. It has been reported that insulin improves the nerve regeneration and myelination through its role as neurotrophic factor.
Aim of the Work: was to compare the short-term effects of insulin and corticosteroid local injections in the treatment of diabetic patients with carpal tunnel syndrome.
Patients and Methods: Fifty diabetic patients with clinical and electrophysiological evidence of mild to moderate carpal tunnel syndrome were included in this study. All Patients had been sub-classified into two equal groups:- Group (1): Twenty five patients have received local insulin injection of 10 IU Neutral Protamine Hagedorn (NPH) {Insulinagypt N} into the affected carpal tunnel at the first visit and the same dose of insulin after 2 weeks. Group (2): twenty five patients have received a single dose of 40 mg triamcinolone acetonide {Epirelefan} local injection into the affected carpal tunnel. Nerve conduction study (NCS), Boston Carpal Tunnel Questionnaire (BCTQ) and clinical evaluation were carried out for both groups at baseline and four weeks after second dose of insulin injection and one month after steroid injection.
Results: In steroid group, significant improvement in nerve conduction study as regard distal sensory latency and sensory conduction velocity without significant improvement in distal motor latency and motor conduction velocity and significant improvement in (BCTQ). In insulin group, a more significant improvement in all parameters of nerve conduction study and also in (BCTQ) was observed with insulin injection than steroid done. Also, there were significant differences between results of both groups for insulin injection group.
Conclusion: Local insulin injection is an effective treatment for restoring median nerve function in diabetic patients with mild to moderate carpal tunnel syndrome and produce significant improvement in NCS and BCTQ.

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