Efficacy of Ultrasound Versus Landmark- Guided Steroid Injections for Carpal Tunnel Syndrome: A Randomized Double-Blind Trial

Background/Aims: This study compared the mid-term effectiveness of ultrasoundguided (USG) vs. landmark (LM)-guided corticosteroid injections in patients with moderate carpal tunnel syndrome (CTS), evaluating symptom severity, functional status, sonographic and electrophysiological parameters, and complications over 6 months.

Materials and Methods: A prospective, randomized, double-blind trial was conducted on 168 wrists (84 participants) with bilateral moderate CTS. Participants were divided into LM-guided and USG injection groups. Primary outcomes included the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) Symptom Severity Scale (SSS) and Functional Status Scale (FSS). Secondary outcomes were grip strength (GS), median nerve cross-sectional area (MNSA), median nerve flattening ratio (MNFR), and electrophysiological parameters. Assessments were performed at baseline, 1 month, and 6 months post injection.

Results: Both groups showed significant improvements in BCTQ-SSS, BCTQ-FSS, GS, MNSA, MNFR, and electrophysiological parameters at 1 and 6 months (P < .05). No significant differences were observed between the 2 techniques in efficacy. However, hypopigmentation occurred more frequently in the LM group (11% vs. 3%, P = .04). No severe complications were reported.

Conclusion: The USG and LM-guided corticosteroid injections are equally effective for moderate CTS over 6 months. While USG may reduce minor complications like hypopigmentation, both methods are safe and viable options when performed by experienced clinicians.

Cite this article as: Topcu-Altın N, Sarı MH, Bilgilisoy-Filiz M, et al. Efficacy of ultrasound versus landmark-guided steroid injections for carpal tunnel syndrome: A randomized doubleblind trial. ArchRheumatol. 2026;41(1):22-28.