The Safest Location for Steroid Injection in the Treatment of Carpal Tunnel Syndrome

2005 ◽  
Vol 30 (4) ◽  
pp. 412-414 ◽  
Author(s):  
O. RACASAN ◽  
TH. DUBERT
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Steroid Injection ◽  
Major Complication ◽  
Longus Tendon ◽  
Palmaris Longus ◽  
Flexor Carpi Ulnaris ◽  
Tunnel Syndrome ◽  
Palmaris Longus Tendon

Steroid injections are routinely performed for carpal tunnel syndrome. Direct needle injury of the median nerve is the major complication of these injections. The safest location of the injection remains controversial. The purpose of this study is to define safe guidelines to avoid nerve injury. The distances between the Median nerve, Palmaris Longus, Flexor Carpi Ulnaris and Flexor Carpi Radialis tendons were measured preoperatively, 1 cm proximal to the distal wrist crease in 93 endoscopic carpal tunnel releases. We found that the median nerve extended ulnarly beyond the Palmaris Longus tendon in 82 hands (88%). It is concluded that the median nerve is at risk if the injection is performed within 1 cm on either the ulnar or radial side of the Palmaris Longus tendon. More ulnarly, there is risk to the ulnar pedicle. The safest location is to inject through the FCR tendon.

Palmaris profundus in the carpal tunnel

2021 ◽  
Vol 14 (8) ◽  
pp. e241328
Author(s):  
Theodore Paul Pezas ◽  
Rajive Jose
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Anatomical Variant ◽  
Longus Tendon ◽  
Raising Awareness ◽  
Tunnel Syndrome ◽  
Palmaris Longus Tendon ◽  
Secondary Causes

Carpal tunnel release is a routinely performed operation to relieve pressure caused by compression on the median nerve. In the majority of cases, the causation of the compression will be idiopathic. Among the secondary causes of median nerve compression is the palmaris profundus, a rare anatomical variant separate to the palmaris longus tendon. It has been suggested that it may cause carpal tunnel syndrome as it courses underneath the flexor retinaculum with the contents of the carpal tunnel reducing the space available to the median nerve. Several cases have found it intimately associated with the median nerve within the carpal tunnel. Raising awareness of this anatomical variant is therefore important for those undertaking carpal tunnel decompression in order to avoid unintended damage.

The Clinical Significance of the Palmaris Longus Tendon in the Pathophysiology of Carpal Tunnel Syndrome

2006 ◽  
Vol 31 (6) ◽  
pp. 657-660 ◽  
Author(s):  
G. R. KEESE ◽  
M. D. WONGWORAWAT ◽  
G. FRYKMAN
Keyword(s):  
Risk Factor ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Independent Risk Factor ◽  
Prospective Clinical Study ◽  
Absolute Increase ◽  
Longus Tendon ◽  
Palmaris Longus ◽  
Tunnel Syndrome ◽  
Palmaris Longus Tendon

Carpal tunnel syndrome is associated with increased intracarpal canal pressure. The effect of tendon loading on intracarpal canal pressures is documented in biomechanical studies. Palmaris longus loading in wrist extension induces the greatest absolute increase in intracarpal canal pressure. Despite this fact, the palmaris longus is not yet a proven independent risk factor for the development of carpal tunnel syndrome. The purpose of this prospective clinical study was to assess and quantify the association between the presence of a palmaris longus tendon and carpal tunnel syndrome. Thirty-six carpal tunnel subjects with bilateral disease were compared with 36 controls. Each subject was clinically examined for the presence of the palmaris longus tendon. The prevalence of palmaris longus agenesis was significantly lower in the carpal tunnel group. The palmaris longus tendon is a strong independent risk factor for carpal tunnel syndrome.

scholarly journals The Palmaris Longus and Its Association with Carpal Tunnel Syndrome

2020 ◽  
Vol 9 (06) ◽  
pp. 493-497
Author(s):  
Andrew D. Boltuch ◽  
Michael A. Marcotte ◽  
Christopher M. Treat ◽  
Anthony L. Marcotte
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Carpal Tunnel ◽  
Predictive Value ◽  
Carpal Tunnel Release ◽  
Longus Tendon ◽  
Palmaris Longus ◽  
Tunnel Syndrome ◽  
Palmaris Longus Tendon

Abstract Background The palmaris tendon inserts into the palmar fascia and is positioned in close association with the transverse carpal ligament. Loading of this tendon has been demonstrated to increase carpal tunnel pressures. Purpose The purpose of this study was to determine if a relationship exists between the palmaris tendon, carpal tunnel syndrome (CTS), and handedness. The sensitivity, specificity, positive predictive value, and negative predictive value for Schaeffer's test were calculated. Methods A retrospective review of patient charts undergoing endoscopic carpal tunnel release was performed. Rates of palmaris longus agenesis (PLA) were compared to a population matched data set. Statistical analysis was performed using a one-proportion z-test. Schaeffer's test for the palmaris longus tendon was performed on all patients and compared to intraoperative confirmation. Results A total of 520 carpal tunnel releases were performed in 389 consecutive patients. The frequency of PLA in this surgical cohort was significantly lower compared to the population matched dataset. No correlation between handedness and laterality of CTS or PLA was found. Schaeffer's test was evaluated to yield sensitivity (93.6%), specificity (100%), positive predictive value (100%), and negative predictive value (50.8%). Conclusion The palmaris tendon was more prevalent in a population of patients undergoing carpal tunnel release. These findings can be used to provide further insight into the pathophysiology of CTS. While Schaeffer's test was accurate in detecting the palmaris longus tendon, a negative test was frequently incorrect. Further imaging is recommended in patients with a negative Schaeffer's test when the palmaris longus is desired for surgical utilization. Level of Evidence This is a Level III, prognostic study.

scholarly journals Anomalous Palmaris Longus Tendon Causing Carpal Tunnel Syndrome

2019 ◽  
Vol 52 (03) ◽  
pp. 360-361
Author(s):  
Harsh R. Shah ◽  
Amita Hiremath ◽  
Mukund R. Thatte
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Longus Tendon ◽  
Palmaris Longus ◽  
Tunnel Syndrome ◽  
Palmaris Longus Tendon

Surgery of the carpal tunnel

1978 ◽  
Vol 49 (2) ◽  
pp. 316-318 ◽  
Author(s):  
Noel Eboh ◽  
Donald H. Wilson
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Modified Technique ◽  
Content Type ◽  
Electrical Studies ◽  
Entrapment Neuropathies ◽  
Palmaris Longus ◽  
Tunnel Syndrome ◽  
Fine Print

✓ The authors describe a modified technique for surgery of the carpal tunnel. The primary cause of the carpal tunnel syndrome is the same as other entrapment neuropathies: an enlarged nerve within a tight tunnel. Electrical studies have shown that the area of compression is in the middle of the tunnel. Treatment is surgical: a palmar incision, which begins at the wrist medial to the palmaris longus, to avoid damage to the sensory branch of the median nerve; and section of the retinaculum from the exit of the tunnel toward the entrance.

scholarly journals MRI-Based Identification of an Appropriate Point of Needle Insertion for Patients with Idiopathic Carpal Tunnel Syndrome to Avoid Median Nerve Injury

2011 ◽  
Vol 2011 ◽  
pp. 1-5
Author(s):  
Shigeharu Uchiyama ◽  
Toshiro Itsubo ◽  
Koichi Nakamura ◽  
Hironori Murakami ◽  
Toshimitsu Momose ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Distal Radioulnar Joint ◽  
Needle Insertion ◽  
Cross Sectional ◽  
Flexor Carpi Ulnaris ◽  
Entry Points ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome

To identify a safe entry point for needle insertion in patients with idiopathic carpal tunnel syndrome (CTS), cross-sectional images of the wrist MRI of 45 normal volunteers and 180 consecutive patients with idiopathic CTS were reviewed. Insertion of the needle from the five different entry points into the carpal tunnel was simulated by drawing a 1-pixel line, and the incidence of contact with the median nerve was compared. In the CTS patients, the lowest incidence was 3% when inserted at one-third of the length between the FCR and FCU tendons on the ulnar side at the level of the distal part of the distal radioulnar joint and 4% at the mid point between the palmaris longus tendona and the flexor carpi ulnaris tendon. It was greater in the advanced stage of CTS than the less severe CTS. We recommend those two entry points.

Sign in / Sign up

Export Citation Format

Share Document