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The effect of botulinum toxin type A injection in decreasing intratunnel tendon tension in carpal tunnel syndrome: a randomized controlled trial for efficacy and safety

Egyptian Rheumatology and Rehabilitation volume 46, pages 299–303 (2019)Cite this article

Abstract

Aim

To evaluate the efficacy of botulinum toxin A on relieving the clinical symptoms caused by median nerve compression in patients with carpal tunnel syndrome.

Patients and methods

An imbalanced randomization (3 : 1) placebo-controlled parallel group study for efficacy and safety was conducted in Tanta University, Egypt. Group I Received Botox injection. Group II Received the same amount of normal saline as Botox injection and at the same injection points as group I. All patients were subjected to clinical assessment and electrophysiological assessment of the median nerve before and after 12 weeks.

Results

Highly significant improvements were noted in group I regarding clinical symptoms and electrophysiological study of the median nerve, whereas group II showed significant improvement in clinical symptoms but no improvement in the electrophysiological study, with significant difference between the two groups.

Conclusion

Botox injection can be used safely as a treatment option in moderate carpal tunnel syndrome.

References

  1. Dorwart BB. Carpal tunnel syndrome: a review. Semin Arthritis Rheum 1984; 14:134–140.

    Article  CAS  PubMed  Google Scholar 

  2. Martinoli C, Bianchi S, Gandolfo N, Valle M, Simonetti S, Derchi LE. US of nerve entrapments in osteofibrous tunnels of the upper and lower limbs. Radiographics 2000; 20:S199–S217.

    Article  PubMed  Google Scholar 

  3. Ibrahim I, Khan WS, Goddard N, Smitham P. Carpal tunnel syndrome: a review of the recent literature. Open Orthop J 2012; 6:69–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Bickel KD. Carpal tunnel syndrome. J Hand Surg Am 2010; 35:147–152.

    Article  PubMed  Google Scholar 

  5. Nunez F, Vranceanu AM, Ring D. Determinants of pain in patients with carpal tunnel syndrome. Clin Orthop Relat Res 2010; 468:3328–3332.

    Article  PubMed  PubMed Central  Google Scholar 

  6. McCartan B, Ashby E,Taylor EJ, Haddad FS. Carpal tunnel syndrome. Br J Hosp Med (Lon) 2012; 73:199–202.

    Article  Google Scholar 

  7. Katz JN, Simmons BP. Clinical practice. Carpal tunnel syndrome. N Engl J Med 2002; 346:1807–1812.

    Article  PubMed  Google Scholar 

  8. Aroori S, Spence RA. Carpal tunnel syndrome. Ulster Med J 2008; 77:6–17.

    PubMed  PubMed Central  Google Scholar 

  9. Walkerand JennieA. Management of patients with carpal tunnel syndrome. Nurs Stand 2010; 24:44–48.

    Article  Google Scholar 

  10. Uemura T, Hidaka N, Nakamura H, Hidaka N. Clinical outcome of carpal tunnel release with and without opposition transfer. J Hand Surg Eur Vol 2010; 35:632–636.

    Article  CAS  PubMed  Google Scholar 

  11. Graham B, Regehr G, Naglie G, Wright JG. Development and validation of diagnostic criteria for carpal tunnel syndrome. J Hand Surg Am 2006; 31:919–924.

    PubMed  Google Scholar 

  12. Wiesler ER, Chloros GD, Cartwright MS, Smith BP. The use of diagnostic ultrasound in carpal tunnel syndrome. J Hand Surg Am 2006; 31:726–732.

    Article  PubMed  Google Scholar 

  13. Piazzini DB, Aprile I, Ferrara PE, Bertolini C. A systematic review of conservative treatment of carpal tunnel syndrome. Clin Rehabil 2007; 21:299–314.

    Article  CAS  PubMed  Google Scholar 

  14. Bihari K. Safety, effectiveness and duration of effect of BOTOX after switching from Dysport for blepharospasm, cervical dystonia, and hemifacial spasm. Curr Med Res Opin 2005; 21:433–438.

    Article  CAS  PubMed  Google Scholar 

  15. Naumann M, So Y, Argoff CE, Childers MK. Assessment of Botulinum neurotoxin in the treatment of autonomic disorders and pain (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2008; 70:1707–1714.

    Article  CAS  PubMed  Google Scholar 

  16. Bland JDP. A neurophysiological grading scale for carpal tunnel syndrome. Muscle Nerve 2000; 23:1280–1283.

    Article  CAS  PubMed  Google Scholar 

  17. Levine DW. A self administrated questionnaire for the assessment of severity of symptoms and functional status in CTS. J Bone Joint Surg 1993; 70:1585–1592.

    Article  Google Scholar 

  18. Burton C, Chesterton LS, Davenport G. Diagnosing and managing carpal tunnel syndrome in primary care. Br J Gen Pract 2014; 64:262–263.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Carpal Tunnel Syndrome Fact Sheet. National Institute of Neurological Disorders and Stroke. January 28, 2016. http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm. Retrieved March 2017.

  20. Schuind F, Ventura M, Pasteels J. Idiopathic carpal tunnel syndrome: histologic study of flexor tendon synovium. J Hand Surg Am 1990; 15:497–503.

    Article  CAS  PubMed  Google Scholar 

  21. Armstrong T, Chaffin D. Capral tunnel syndrome and selected personal attributes. J Occup Med 1979; 12:481–486.

    Google Scholar 

  22. Bright DS, Urbaniak J. Direct measures of flexor tendon tension during active and passive digit motion and its application to flexor tendon surgery. Trans Orthop Res Soc 1976; 1:240.

    Google Scholar 

  23. Schuind F, Garcia-Elias M, Cooney WP, An KN. Flexor tendon forces: in vivo measurements. J Hand Surg Am 1992; 17:291–298.

    Article  CAS  PubMed  Google Scholar 

  24. El Mallah R, Elattar EA, Zidan HF. Platelet-rich plasma versus dry needling of myofascial meridian trigger points in the treatment of plantar fasciitis. Egypt Rheumatol Rehabil 2017; 44:58–68.

    Article  Google Scholar 

  25. Tsai CP, Liu CY, Lin KP, Wang KC. Efficacy of botulinum toxin type a in the relief of Carpal tunnel syndrome: a preliminary experience. Clin Drug Investig 2006; 26:511–515.

    Article  CAS  PubMed  Google Scholar 

  26. Sucher B. BOTOX® (Onabotulinumtoxin A) Injection(s) as a treatment for carpal tunnel syndrome. Available at: https://clinicaltrials.gov/ct2/show/record/NCT02070302. [Available 25 January 2018].

  27. Francisco J. Juan-García, Jacobo Formigo-Couceiro, Manuela Barrio-Alonsoand, Rubén Ouviña-Arribas. Effectiveness of botulinum toxin type A in carpal tunnel syndrome. J Musculoskelet Res 2016; 19:02.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Rheumatology and Rehabilitation, Faculty of Medicine, Tanta University, Tanta, 31 111, Egypt

    Shymaa A. Hablas MD, Doaa W. Nada & Doaa S. Alashkar

  2. Department of Neurosurgery, Faculty of Medicine, Tanta University, Tanta, Egypt

    Ahmed A. Elsharkawy

Authors
  1. Shymaa A. Hablas MD
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  2. Doaa W. Nada
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  3. Doaa S. Alashkar
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  4. Ahmed A. Elsharkawy
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Corresponding author

Correspondence to Shymaa A. Hablas MD.

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Hablas, S.A., Nada, D.W., Alashkar, D.S. et al. The effect of botulinum toxin type A injection in decreasing intratunnel tendon tension in carpal tunnel syndrome: a randomized controlled trial for efficacy and safety. Egypt Rheumatol Rehabil 46, 299–303 (2019). https://doi.org/10.4103/err.err_35_19

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  • DOI: https://doi.org/10.4103/err.err_35_19

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