{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T18:08:02Z","timestamp":1781287682534,"version":"3.54.1"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2021,3,22]],"date-time":"2021-03-22T00:00:00Z","timestamp":1616371200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100019000","name":"Ministry of National Defense-Medical Affairs Bureau","doi-asserted-by":"publisher","award":["MAB-107-072"],"award-info":[{"award-number":["MAB-107-072"]}],"id":[{"id":"10.13039\/501100019000","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To investigate the effect of hyaluronic acid (HA) in patients diagnosed with mild or moderate carpal tunnel syndrome (CTS).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>A prospective randomized, double-blinded control study with 6\u2009months of follow-up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Rehabilitation outpatient clinic of one single medical center.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Subjects<\/jats:title>\n                  <jats:p>Thirty-five participants with mild or moderate CTS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Participants were enrolled and randomly assigned to HA or control groups. The HA group received one ultrasound-guided perineural injection of 2.5\u2009mL HA while the control group received 2.5\u2009mL normal saline injection through in-plane, long-axis approach to separate the median nerve from the flexor retinaculum via nerve hydrodissection. Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scores were the primary outcome, while secondary outcomes included the numeric rating scale (NRS), electrophysiological domains, and the cross-sectional area of the median nerve. The assessment was conducted prior to injection and during the second week and 1-, 3-, and 6-months post-injection.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Thirty-two patients (17 wrists in HA group and 15 wrists in control group) completed the study. Compared with the control group, the HA group did not show significantly superior outcomes, except in BCTQ and NRS at the second week post-injection (all P\u2009&amp;lt;\u2009.0125).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>A single ultrasound guided perineural HA injection may have short-term therapeutic efficacy for mild or moderate CTS; however, the 2-weeks superior efficacy was not beneficial for chronic neuropathy. Further studies with larger sample sizes are required to verify its therapeutic efficacy.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/pm\/pnab109","type":"journal-article","created":{"date-parts":[[2021,3,19]],"date-time":"2021-03-19T12:10:52Z","timestamp":1616155852000},"page":"2676-2685","source":"Crossref","is-referenced-by-count":21,"title":["The Efficacy of Hyaluronic Acid for Carpal Tunnel Syndrome: A Randomized Double-Blind Clinical Trial"],"prefix":"10.1093","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6771-9330","authenticated-orcid":false,"given":"Yu-Chi","family":"Su","sequence":"first","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Neihu, Taipei, Taiwan, Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Ping","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Neihu, Taipei, Taiwan, Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsung-Ying","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Neihu, Taipei, Taiwan, Republic of China"},{"name":"Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Neihu, Taipei, Taiwan, Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsung-Yen","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Neihu, Taipei, Taiwan, Republic of China"},{"name":"Department of Physical Medicine and Rehabilitation, Taichung Armed Forces General Hospital, Taiping, Taichung City, Taiwan, Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang-Cheng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Neihu, Taipei, Taiwan, Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1175-7909","authenticated-orcid":false,"given":"Yung-Tsan","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Neihu, Taipei, Taiwan, Republic of China"},{"name":"Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Neihu, Taipei, Taiwan, Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,3,22]]},"reference":[{"issue":"12","key":"2021120107504446900_pnab109-B1","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1016\/S1474-4422(16)30231-9","article-title":"Carpal tunnel syndrome: Clinical features, diagnosis, and management","volume":"15","author":"Padua","year":"2016","journal-title":"Lancet Neurol"},{"issue":"2","key":"2021120107504446900_pnab109-B2","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1001\/jama.282.2.153","article-title":"Prevalence of carpal tunnel syndrome in a general population","volume":"282","author":"Atroshi","year":"1999","journal-title":"Jama"},{"issue":"6","key":"2021120107504446900_pnab109-B3","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1002\/jor.23113","article-title":"Effect of radial shock wave therapy for carpal tunnel syndrome: A prospective randomized, double-blind, placebo-controlled trial","volume":"34","author":"Wu","year":"2016","journal-title":"J Orthop Res"},{"issue":"1","key":"2021120107504446900_pnab109-B4","first-page":"CD003219","article-title":"Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome","volume":"2003","author":"O'Connor","year":"2003","journal-title":"Cochrane Database Syst Rev"},{"issue":"4","key":"2021120107504446900_pnab109-B5","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1002\/ana.25332","article-title":"Randomized double-blinded clinical trial of 5% dextrose versus triamcinolone injection for carpal tunnel syndrome patients","volume":"84","author":"Wu","year":"2018","journal-title":"Ann Neurol"},{"issue":"3","key":"2021120107504446900_pnab109-B6","doi-asserted-by":"crossref","first-page":"49","DOI":"10.3390\/ph13030049","article-title":"Regenerative injections including 5% dextrose and platelet-rich plasma for the treatment of carpal tunnel syndrome: A systematic review and network meta-analysis","volume":"13","author":"Lin","year":"2020","journal-title":"Pharmaceuticals (Basel)"},{"issue":"2","key":"2021120107504446900_pnab109-B7","first-page":"CD001554","article-title":"Local corticosteroid injection for carpal tunnel syndrome","author":"Marshall","year":"2007","journal-title":"Cochrane Database Syst Rev"},{"issue":"5","key":"2021120107504446900_pnab109-B8","doi-asserted-by":"crossref","first-page":"309","DOI":"10.7326\/0003-4819-159-5-201309030-00004","article-title":"Methylprednisolone injections for the carpal tunnel syndrome: A randomized, placebo-controlled trial","volume":"159","author":"Atroshi","year":"2013","journal-title":"Ann Intern Med"},{"issue":"1","key":"2021120107504446900_pnab109-B9","doi-asserted-by":"crossref","first-page":"234","DOI":"10.4103\/aer.AER_2_18","article-title":"Effect of dexamethasone on characteristics of supraclavicular nerve block with bupivacaine and ropivacaine: A prospective, double-blind randomized control trial","volume":"12","author":"Bindal","year":"2018","journal-title":". Anesth Essays Res"},{"issue":"8","key":"2021120107504446900_pnab109-B10","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1016\/j.mayocp.2017.05.025","article-title":"Six-month efficacy of perineural dextrose for carpal tunnel syndrome: A prospective, randomized, double-blind, controlled trial","volume":"92","author":"Wu","year":"2017","journal-title":"Mayo Clin Proc"},{"issue":"2","key":"2021120107504446900_pnab109-B11","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1093\/rheumatology\/keaa361","article-title":"Long-term outcome after perineural injection with 5% dextrose for carpal tunnel syndrome: A retrospective follow-up study","volume":"60","author":"Li","year":"2021","journal-title":"Rheumatology (Oxford)"},{"key":"2021120107504446900_pnab109-B12","volume-title":"Harrison's Online Updates","author":"Josephson","year":"2018"},{"issue":"5","key":"2021120107504446900_pnab109-B13","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1016\/j.apmr.2019.10.193","article-title":"Effectiveness of platelet-rich plasma injections for nonsurgical management of carpal tunnel syndrome: A systematic review and meta-analysis of randomized controlled trials","volume":"101","author":"Catapano","year":"2020","journal-title":"Arch Phys Med Rehabil"},{"key":"2021120107504446900_pnab109-B14","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1186\/1471-2474-7-96","article-title":"A systematic review of outcomes assessed in randomized controlled trials of surgical interventions for carpal tunnel syndrome using the International Classification of Functioning, Disability and Health (ICF) as a reference tool","volume":"7","author":"Jerosch-Herold","year":"2006","journal-title":"BMC Musculoskelet Disord"},{"issue":"15","key":"2021120107504446900_pnab109-B15","doi-asserted-by":"crossref","first-page":"551","DOI":"10.5435\/JAAOS-D-18-00004","article-title":"Management of recalcitrant carpal tunnel syndrome","volume":"27","author":"Lauder","year":"2019","journal-title":"J Am Acad Orthop Surg"},{"issue":"1","key":"2021120107504446900_pnab109-B16","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1249\/JSR.0000000000000226","article-title":"Ultrasound-guided nerve hydrodissection: What is it? A review of the literature","volume":"15","author":"Cass","year":"2016","journal-title":"Curr Sports Med Rep"},{"issue":"2","key":"2021120107504446900_pnab109-B17","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1002\/mus.26358","article-title":"Nerve hydrodissection for carpal tunnel syndrome: A prospective, randomized, double-blind, controlled trial","volume":"59","author":"Wu","year":"2019","journal-title":"Muscle Nerve"},{"key":"2021120107504446900_pnab109-B18","doi-asserted-by":"crossref","first-page":"1957","DOI":"10.2147\/JPR.S247208","article-title":"Ultrasound-guided nerve hydrodissection for pain management: Rationale, methods, current literature, and theoretical mechanisms","volume":"13","author":"Lam","year":"2020","journal-title":"J Pain Res"},{"issue":"2","key":"2021120107504446900_pnab109-B19","doi-asserted-by":"crossref","first-page":"97","DOI":"10.2217\/pmt-2019-0056","article-title":"Ultrasound imaging and guidance in peripheral nerve entrapment: Hydrodissection highlighted","volume":"10","author":"Chang","year":"2020","journal-title":"Pain Manag"},{"issue":"8","key":"2021120107504446900_pnab109-B20","doi-asserted-by":"crossref","first-page":"1800","DOI":"10.3390\/polym12081800","article-title":"Hyaluronic acid: The influence of molecular weight on structural, physical, physico-chemical, and degradable properties of biopolymer","volume":"12","author":"Snetkov","year":"2020","journal-title":"Polymers (Basel)"},{"issue":"2","key":"2021120107504446900_pnab109-B21","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1006\/jsre.2001.6248","article-title":"Prevention of postsurgical adhesions with an autocrosslinked hyaluronan derivative gel","volume":"100","author":"Belluco","year":"2001","journal-title":"J Surg Res"},{"issue":"9","key":"2021120107504446900_pnab109-B22","doi-asserted-by":"crossref","first-page":"1918","DOI":"10.1093\/humrep\/deg368","article-title":"Effectiveness of auto-cross-linked hyaluronic acid gel in the prevention of intrauterine adhesions after hysteroscopic adhesiolysis: A prospective, randomized, controlled study","volume":"18","author":"Acunzo","year":"2003","journal-title":"Hum Reprod"},{"issue":"6","key":"2021120107504446900_pnab109-B23","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1002\/micr.10209","article-title":"Effects of hyaluronic acid on peripheral nerve scarring and regeneration in rats","volume":"23","author":"Ozgenel","year":"2003","journal-title":"Microsurgery"},{"issue":"2","key":"2021120107504446900_pnab109-B24","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/S0015-0282(98)00496-8","article-title":"A novel hyaluronan-based gel in laparoscopic adhesion prevention: Preclinical evaluation in an animal model","volume":"69","author":"De Laco","year":"1998","journal-title":"Fertil Steril"},{"issue":"1","key":"2021120107504446900_pnab109-B25","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1002\/micr.20299","article-title":"Clinical evaluation of a hyaluronan-based gel following microsurgical reconstruction of peripheral nerves of the hand","volume":"27","author":"Atzei","year":"2007","journal-title":"Microsurgery"},{"issue":"3","key":"2021120107504446900_pnab109-B26","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1007\/BF02048482","article-title":"Neurophysiological classification of carpal tunnel syndrome: Assessment of 600 symptomatic hands","volume":"18","author":"Padua","year":"1997","journal-title":"Ital J Neurol Sci"},{"issue":"11","key":"2021120107504446900_pnab109-B27","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.2106\/00004623-199311000-00002","article-title":"A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome","volume":"75","author":"Levine","year":"1993","journal-title":"J Bone Jt Surg American Volume"},{"key":"2021120107504446900_pnab109-B28","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1186\/1471-2474-7-78","article-title":"A systematic review of the psychometric properties of the Boston Carpal Tunnel Questionnaire","volume":"7","author":"Leite","year":"2006","journal-title":"BMC Musculoskelet Disord"},{"issue":"7","key":"2021120107504446900_pnab109-B29","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1111\/j.1365-2702.2005.01121.x","article-title":"Pain: A review of three commonly used pain rating scales","volume":"14","author":"Williamson","year":"2005","journal-title":"J Clin Nurs"},{"issue":"2","key":"2021120107504446900_pnab109-B30","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/S0304-3959(01)00349-9","article-title":"Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale","volume":"94","author":"Farrar","year":"2001","journal-title":"Pain"},{"issue":"4","key":"2021120107504446900_pnab109-B31","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1016\/j.clinbiomech.2015.02.015","article-title":"Pathological changes in the subsynovial connective tissue increase with self-reported carpal tunnel syndrome symptoms","volume":"30","author":"Tat","year":"2015","journal-title":"Clin Biomech (Bristol)"},{"issue":"12","key":"2021120107504446900_pnab109-B32","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.1177\/0284185118762246","article-title":"Usefulness of ultrasound assessment of median nerve mobility in carpal tunnel syndrome","volume":"59","author":"Park","year":"2018","journal-title":"Acta Radiol"},{"issue":"4","key":"2021120107504446900_pnab109-B33","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1002\/mus.25101","article-title":"Effect of finger motion on transverse median nerve movement in the carpal tunnel","volume":"54","author":"Kang","year":"2016","journal-title":"Muscle Nerve"},{"issue":"3","key":"2021120107504446900_pnab109-B34","doi-asserted-by":"crossref","first-page":"417","DOI":"10.4103\/aer.AER_104_19","article-title":"Dexamethasone versus hyaluronidase as an adjuvant to local anesthetics in the ultrasound-guided hydrodissection of the median nerve for the treatment of Carpal Tunnel Syndrome patients","volume":"13","author":"Alsaeid","year":"2019","journal-title":"Anesth Essays Res"},{"issue":"4","key":"2021120107504446900_pnab109-B35","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1111\/jocd.12237","article-title":"Physiochemical properties and application of hyaluronic acid: A systematic review","volume":"15","author":"Salwowska","year":"2016","journal-title":"J Cosmet Dermatol"},{"issue":"4","key":"2021120107504446900_pnab109-B36","doi-asserted-by":"crossref","first-page":"648","DOI":"10.3171\/jns.2004.101.4.0648","article-title":"Reduction of neural adhesions by biodegradable autocross-linked hyaluronic acid gel after injury of peripheral nerves: An experimental study","volume":"101","author":"Smit","year":"2004","journal-title":"J Neurosurg"},{"issue":"4","key":"2021120107504446900_pnab109-B37","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/S0007-1226(03)00197-8","article-title":"Hyaluronic acid prevents peripheral nerve adhesion","volume":"56","author":"Ikeda","year":"2003","journal-title":"Br J Plast Surg"},{"issue":"8","key":"2021120107504446900_pnab109-B38","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/0007-1226(91)90093-Y","article-title":"Hyaluronan and wound healing: A new perspective","volume":"44","author":"Burd","year":"1991","journal-title":"Br J Plast Surg"},{"key":"2021120107504446900_pnab109-B39","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1186\/s13018-014-0094-3","article-title":"Application of topical pharmacological agents at the site of peripheral nerve injury and methods used for evaluating the success of the regenerative process","volume":"9","author":"Mekaj","year":"2014","journal-title":"J Orthop Surg Res"},{"issue":"3","key":"2021120107504446900_pnab109-B40","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1002\/micr.22196","article-title":"Effect of VEGF gene therapy and hyaluronic acid film sheath on peripheral nerve regeneration","volume":"34","author":"Zor","year":"2014","journal-title":"Microsurgery"},{"key":"2021120107504446900_pnab109-B41","author":"Campa","year":"2015"},{"issue":"2","key":"2021120107504446900_pnab109-B42","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1177\/1071100717739578","article-title":"Ultrasound-guided hyaluronic acid injection for the management of Morton's neuroma","volume":"39","author":"Lee","year":"2018","journal-title":"Foot Ankle Int"},{"issue":"1","key":"2021120107504446900_pnab109-B43","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1002\/bjs.4006","article-title":"Effect of antiadhesive agents on peritoneal carcinomatosis in an experimental model","volume":"90","author":"Pucciarelli","year":"2003","journal-title":"Br J Surg"},{"issue":"12","key":"2021120107504446900_pnab109-B44","doi-asserted-by":"crossref","first-page":"2120","DOI":"10.1016\/j.apmr.2015.08.421","article-title":"Ultrasound-guided hyaluronic acid injections for trigger finger: A double-blinded, randomized controlled trial","volume":"96","author":"Liu","year":"2015","journal-title":"Arch Phys Med Rehabil"},{"key":"2021120107504446900_pnab109-B45","doi-asserted-by":"crossref","DOI":"10.1016\/j.apmr.2020.12.025","article-title":"One-year efficacy of platelet-rich plasma for moderate-to-severe carpal tunnel syndrome: A prospective, randomized, double-blind, controlled trial","author":"Chen","year":"2021","journal-title":"Arch Phys Med Rehabil"},{"issue":"2","key":"2021120107504446900_pnab109-B46","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.expneurol.2012.04.019","article-title":"Improved rate of peripheral nerve regeneration induced by extracorporeal shock wave treatment in the rat","volume":"236","author":"Hausner","year":"2012","journal-title":"Exp Neurol"}],"container-title":["Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/painmedicine\/advance-article-pdf\/doi\/10.1093\/pm\/pnab109\/37737044\/pnab109.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/painmedicine\/article-pdf\/22\/11\/2676\/41362638\/pnab109.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/painmedicine\/article-pdf\/22\/11\/2676\/41362638\/pnab109.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T12:20:14Z","timestamp":1638361214000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/painmedicine\/article\/22\/11\/2676\/6179816"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,22]]},"references-count":46,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,3,22]]},"published-print":{"date-parts":[[2021,11,26]]}},"URL":"https:\/\/doi.org\/10.1093\/pm\/pnab109","relation":{},"ISSN":["1526-2375","1526-4637"],"issn-type":[{"value":"1526-2375","type":"print"},{"value":"1526-4637","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,11,1]]},"published":{"date-parts":[[2021,3,22]]}}}