Perineural Steroid Injections in Cubital Tunnel Syndrome: A Systematic Review and Meta-Analysis

TL;DR

This study reviews evidence on perineural steroid injections for cubital tunnel syndrome, finding they improve symptoms but not objective measures like ultrasound or nerve conduction.

Contribution

The study provides a systematic review and meta-analysis of perineural steroid injections for cubital tunnel syndrome, highlighting their clinical benefits and safety.

Findings

Perineural steroid injections improved clinical symptoms and patient-reported outcomes in cubital tunnel syndrome.

No significant objective improvement was observed in ultrasound or nerve conduction studies.

Steroid injections were found to be a safe and useful diagnostic and adjunctive treatment.

Abstract

Cubital tunnel syndrome (CuTS) is a prevalent mononeuropathy, although the role of perineural steroid injections (PSI) remains uncertain. This meta-analysis and systematic review sought to compile and evaluate all available evidence regarding the potential benefits of PSI. The performance of PSI was assessed objectively using ultrasound (US) and nerve conduction studies NCS), and evaluated clinically through patient-reported questionnaires. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was performed across PubMed, Embase, and Medline databases. Common outcomes and control groups were categorised together. Meta-analysis was performed where possible, while narrative synthesis was used for studies with substantial heterogeneity. A risk of bias assessment was also undertaken.

The search yielded a total of 1751 papers. Nine studies met the inclusion criteria, encompassing 357 cases of CuTS. Clinically, patients who received PSI performed significantly better on clinical questionnaires and reported improved global symptom ratings. PSI was shown to be a useful adjunct compared with other treatment modalities, such as surgery and splinting. Steroid injections were also shown to be a reliable diagnostic tool in clinically uncertain cases of CuTS. No significant complication profile was identified with PSI. Meta-analysis of pooled results revealed no significant improvement in US findings or NCS.

PSI was found to alleviate symptoms and signs of CuTS across a range of clinical tools and questionnaires. It represents a safe therapeutic modality that could serve a valuable adjunctive and diagnostic function. Objective improvement on imaging or electromyographic studies was not observed. Additional longitudinal studies with larger sample sizes are required. There is also a need for further comparisons between different treatment options.

Figures