Poster 317 Dose-Related Response to Ultrasound-Guided Ulnar In-Plane Median Nerve Steroid Injections for Carpal Tunnel Syndrome: A Case Report

Carpal tunnel syndrome is characterised by compression of the median nerve. The mainstay of treatment is surgical decompression. This case report highlights the occurrence of a persistent median artery, which could complicate surgery. A 55-year-old woman underwent carpal tunnel decompression. An incidental finding of a large-calibre persistent median artery, which was superficial to the flexor sheath, could have been damaged. This was carefully retracted and the procedure was completed, without any complications. Several studies have shown the prevalence of persistent median artery to range from 1.1–27.1%. It is usually found deep to the flexor retinaculum but in this case it was found to be just beneath the palmar fascia. There is increased chance of iatrogenic injury with this particular variant. Surgeons performing the procedure should be mindful of this variation, because accidental damage could result in devastating consequences to the hand.

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EXTRASKELETAL CHONDROMA AS A CAUSE OF CARPAL TUNNEL SYNDROME: A CASE REPORT

Hand Surgery ◽

10.1142/s0218810405002954 ◽

2005 ◽

Vol 10 (02n03) ◽

pp. 327-330 ◽

Cited By ~ 5

Author(s):

D. Cumming ◽

A. Massraf ◽

J. W. M. Jones

Keyword(s):

Case Report ◽

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Clinical Examination ◽

Carpal Tunnel ◽

Common Causes ◽

Tunnel Syndrome ◽

Uncommon Condition ◽

The Common ◽

Space Occupying Lesion

We report a case of carpal tunnel syndrome as a result of an extraosseous chondroma in a 47-year-old gentleman. This case demonstrates the importance of clinical examination and occasional radiographs in this not uncommon condition. We also highlight that this well known entrapment syndrome is not only caused by the common causes that we all know, but also any space-occupying lesion in the carpal tunnel compressing the median nerve.

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Volume Matters in Ultrasound-Guided Perineural Dextrose Injection for Carpal Tunnel Syndrome: A Randomized, Double-Blinded, Three-Arm Trial

Frontiers in Pharmacology ◽

10.3389/fphar.2020.625830 ◽

2020 ◽

Vol 11 ◽

Author(s):

Meng-Ting Lin ◽

Chun-Li Liao ◽

Ming-Yen Hsiao ◽

Hsueh-Wen Hsueh ◽

Chi-Chao Chao ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Group Analysis ◽

Post Injection ◽

Ultrasound Guided ◽

Electrophysiological Studies ◽

Tunnel Syndrome ◽

Double Blinded

Ultrasound-guided perineural dextrose injection (PDI) has been reported effective for carpal tunnel syndrome (CTS). Higher volume of injectate may reduce adhesion of median nerve from other tissues, but volume-dependent effects of PDI in CTS remain unknown. We aimed to investigate whether PDI with different injectate volumes had different effects for CTS participants. In this randomized, double-blinded, three-arm trial, 63 wrists diagnosed with CTS were randomized into three groups that received ultrasound-guided PDI with either 1, 2 or 4 ml of 5% dextrose water. All participants finished this study. Primary outcome as visual analog scale (VAS) and secondary outcomes including Boston Carpal Tunnel Questionnaire (BCTQ), Disability of the Arm, Shoulder and Hand score (QuickDASH), electrophysiological studies and cross-sectional area (CSA) of the median nerve at carpal tunnel inlet were assessed before and after PDI at the 1st, 4th, 12th and 24th weeks. For within-group analysis, all three groups (21 participants, each) revealed significant improvement from baseline in VAS, BCTQ and QuickDASH at the 1st, 4th, 12th and 24th weeks. For between-group analysis, 4 ml-group yielded better VAS reduction at the 4th and 12th weeks as well as improvement of BCTQ and QuickDASH at the 1st, 4th, and 12th weeks, compared to other groups. No significant between-group differences were observed in electrophysiological studies or median nerve CSA at any follow-up time points. There were no severe complications in this trial, and transient minor adverse effects occurred equally in the three groups. In conclusion, ultrasound-guided PDI with 4 ml of 5% dextrose provided better efficacy than with 1 and 2 ml based on symptom relief and functional improvement for CTS at the 1st, 4th, and 12th week post-injection, with no reports of severe adverse effects. There was no significant difference between the three groups at the 24th-week post-injection follow-up.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03598322.

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