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THU0525 Effect of local insulin injection in the treatment of mild to moderate carpal tunnel syndrome in patients with type 2 diabetes mellitus

Background Carpal tunnel syndrome (CTS) is the most common focal nerve entrapment and is a significant cause of morbidity; this syndrome has a higher incidence in diabetic patients. It has been suggested that insulin influences nerve regeneration in a similar way to that of nerve growth factor. Objectives Aim: The aim of the study was to compare the effectiveness of local insulin injection, with that of local steroid injection and of local steroid followed by insulin injections in treating mild to moderate carpal tunnel syndrome in patients with type 2 diabetes mellitus. Methods Patients and methods: The study included 60 type 2 diabetic patients with electrophysiologic evidence of mild to moderate CTS. They were randomly assigned to three groups: group I received insulin injection of 10 IU Neutral Protamine Hagedorn insulin (NPH insulin) locally into the affected carpal tunnel at the first visit and a similar dose of insulin after 2 weeks; group II received a single injection of 40 mg methylprednisolone acetate injection into the carpal tunnel. And group III received a steroid injection into the carpal tunnel then followed by insulin injection twice after 2 and 4 weeks from the steroid injection. Clinical, electrophysiologic and ultrasonographic evaluations were carried out at the start of the study and at 10 weeks after treatment. Results Results: In all groups, there was significant improvement in symptoms, signs and assessment questionnaires (SS score, FD score, and VAS) after receiving the injection. Also, there was a statistically highly significant improvement in DML, SNCV, PSL, and a statistically significant improvement in Samp in the insulin group. While in steroid group there was a statistically highly significant improvement in PSL, and a statistically significant improvement in SNCV. In the third group (steroid followed by insulin), there was a statistically highly significant improvement in DML, SNCV and PSL. As for ultrasonographic assessment, there was a statistically significant improvement in CSA and PD in all groups. The third group (steroid followed by insulin) showed the best improvement as regard the CSA. Conclusions Conclusion: Local insulin injection was found to be as effective as steroid in reducing the symptoms of CTS and improving electrophysiological and ultrasonographic findings, being a safer alternative for diabetic patients. Our findings suggest that local insulin injection after local steroid injection may be of additional benefit in improving median nerve ultrasonographic parameters in mild to moderate diabetic CTS. Keywords: Type 2 diabetes mellitus, carpal tunnel syndrome, local insulin injection. References [1] Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I. Prevalence of carpal tunnel syndrome in a general population. JAMA1999; 282(2):153–8. [2] Celiker R, Basgöze O, Bayraktar M. Early detection of neurological involvement in diabetes mellitus. Electromyogr Clin Neurophysiol1995; 36(1):29–35. Acknowledgements To all professors and colleagues at Rheumatology and Rehabilitation department, Faculty of medicine, Minia University, Egypt. patients for their appreciable cooperation and respectable follow up. Disclosure of Interest None declared