Poster 260: Trifid Median Nerve: A Rare Finding During Ultrasound Guided Carpal Tunnel Injection

Objective: The aim of this report is to describe a new ultrasound guided technique for carpal tunnel injection and median nerve hydrodissection using distal to proximal approach. Methods: From 2015 to 2019, 827 consecutive injections by distal-to-proximal approach were included using coding information to check for post-procedural skin hypopigmentation, hematoma, seroma, nerve injury, or vascular injury. Results: There were no occurrences of post-procedural skin-hypopigmentation, hematoma or seroma formation, or neurovascular injury. Conclusions: The distal approach carpal tunnel injection is a safe and effective method. It may directly inject the medication into carpal tunnel to avoid skin hypopigmentation from steroid side effect with previous report method, also it may release adhesion of median nerve with surrounding soft tissue by hydrodissection. It helps median nerve compression at outlet of carpal tunnel.

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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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Accuracy of Carpal Tunnel Injection: A Prospective Evaluation of 756 Patients

Hand ◽

10.1177/1558944718787330 ◽

2018 ◽

Vol 15 (1) ◽

pp. 54-58 ◽

Cited By ~ 3

Author(s):

David P. Green ◽

Brendan J. MacKay ◽

Steven J. Seiler ◽

Michael T. Fry

Keyword(s):

Median Nerve ◽

Carpal Tunnel ◽

Corticosteroid Injection ◽

Carpal Tunnel Release ◽

Therapeutic Modality ◽

Injection Technique ◽

Anatomic Landmarks ◽

Injection Techniques ◽

Open Carpal Tunnel Release ◽

Tunnel Injection

Background: Corticosteroid injection into the carpal tunnel is both a diagnostic test and a therapeutic modality in the treatment of carpal tunnel syndrome. Many injection techniques are described in the literature. Improper placement of injection may result in damage to neurovascular structures in the carpal canal or decrease efficacy of the test and/or therapy. The purpose of this study is to determine if carpal tunnel injection using anatomic landmarks is reproducible and safe. A review of the senior author’s injection technique is presented. Methods: Over 8 years, there were 756 attempted placements of a 25-gauge needle into the carpal tunnel in a simulated carpal tunnel injection prior to open carpal tunnel release. The needle was inserted at the wrist crease, just ulnar to palmaris longus. Open carpal tunnel release was subsequently performed, and position of the needle was recorded. Results: In 572 patients (75.7%), the needle was found to be in the carpal tunnel without penetration of contents. The needle was in the carpal tunnel but piercing the median nerve in 66 attempts (8.7%). The carpal tunnel was missed in 118 attempts (15.6%). Conclusions: This is the largest study looking at accuracy of carpal tunnel injection using anatomic landmarks. Our injection accuracy (75.7%) is less than reported in previous studies, which note 82% to 100% accuracy using the same injection technique. This may indicate that carpal tunnel injection is less reliable than previously thought. Safety of carpal tunnel injection remains an important concern. The median nerve was penetrated in 8.7% of attempts.

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