Nerve Injury Following Steroid Injection for Carpal Tunnel Syndrome

1996 ◽  
Vol 21 (2) ◽  
pp. 208-209 ◽  
Author(s):  
S. P. TAVARES ◽  
G. E. B. GIDDINS
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Conservative Treatment ◽  
Median Nerve ◽  
Nerve Injury ◽  
Carpal Tunnel ◽  
Steroid Injection ◽  
The Other ◽  
Nerve Lesion ◽  
Tunnel Syndrome ◽  
Median Nerve Lesion

Two cases of nerve injury are reported following steroid injection as treatment for carpal tunnel syndrome. One caused an ulnar nerve lesion that recovered well. The other caused a more severe median nerve lesion which responded poorly to conservative treatment. Steroid injection for carpal tunnel syndrome is generally safe but nerve injury may occur and is difficult to treat.

Median Nerve Injury from Local Steroid Injection in Carpal Tunnel Syndrome

Neurosurgery ◽  
1990 ◽  
Vol 26 (3) ◽  
pp. 512-515 ◽  
Author(s):  
Mark E. Linskey ◽  
Ricardo Segal
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Nerve Injury ◽  
Carpal Tunnel ◽  
Steroid Injection ◽  
Symptomatic Relief ◽  
Subjective Response ◽  
Injection Injury ◽  
Tunnel Syndrome ◽  
Local Steroid Injection

Abstract Local steroid injections for symptomatic relief of carpal tunnel syndrome have become common in the evaluation and treatment of this disorder; yet reports of median nerve injection injury from this practice are rare. We present a case of nerve injury from a steroid injection in a 24-year-old man with carpal tunnel syndrome that was successfully treated by division of the transverse carpal ligament and neurolysis. The histopathological characteristics of the lesion are presented. and the pathogenesis and treatment of this injury are discussed. Means of avoiding this complication include careful attention to anatomic landmarks as well as to the patient's subjective response during injection and avoidance of the use of local anesthetics.

Bifid Median Nerve Compression due to a Musculotendinous Anomaly of FDS to the Middle Finger

1994 ◽  
Vol 19 (5) ◽  
pp. 616-617 ◽  
Author(s):  
S. FERNANDEZ-GARCIA ◽  
J. PI-FOLGUERA ◽  
F. ESTALLO-MATINO
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Muscle Contraction ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Middle Finger ◽  
The Other ◽  
Nerve Compression ◽  
Musculotendinous Junction ◽  
Median Nerve Compression ◽  
Tunnel Syndrome

A case is presented of a bifid median nerve whose longest portion had a normal course while the other portion passed through a hole in the FDS tendon of the middle finger, at its musculotendinous junction. This caused nerve compression during muscle contraction, producing pain and dysaesthesia in the middle finger suggesting carpal tunnel syndrome.

scholarly journals Anatomical Basis of Ulnar Approach in Carpal Tunnel Injection

2013 ◽  
Vol 3;16 (3;5) ◽  
pp. E191-E198
Author(s):  
Dr. Dong Hwee Kim
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Steroid Injection ◽  
Ulnar Artery ◽  
Injection Technique ◽  
Anatomical Basis ◽  
Number Of Patients ◽  
Tunnel Syndrome ◽  
Local Steroid Injection

Background: Local steroid injection may be an effective conservative treatment for carpal tunnel syndrome; however, the use of a blind injection technique can increase the chance of median nerve or ulnar artery injury due to median nerve swelling or the close proximity of the median nerve and ulnar artery around the distal wrist crease. Objectives: The purpose of this study is to investigate the relative location of the median nerve and ulnar artery to the palmaris longus (PL) tendon around the wrist in carpal tunnel syndrome. Study Design: An observational study. Setting: A university outpatient interventional pain management practice in the Republic of Korea. Methods: Thirty hands of 15 patients with carpal tunnel syndrome and 30 hands of 15 healthy subjects were studied. Ultrasonography was performed to determine the relative relationship of the ulnar artery and median nerve to the PL tendon around the wrist. Results: There were statistically significant differences both in the distance from the medial margin of the PL to the medial end of the median nerve and the distance from the medial end of the median nerve to the lateral end of the ulnar artery at all levels of scanning between the 2 groups. Limitations: Limitations include the inclusion of a small number of patients with carpal tunnel syndrome. Conclusion: It is important to recognize the risk of blind local steroid injection for carpal tunnel syndrome, which is most likely a result of swelling and/or flattening of the median nerve around the distal wrist crease. A real time, ultrasound-guided local steroid injection is preferred as a safe and accurate technique in carpal tunnel syndrome treatment. Key Words: Carpal tunnel syndrome, median nerve, ulnar artery, injection, steroid, injury, ultrasonography, risk, cross-sectional area

scholarly journals The Effectiveness of Ultrasound-Guided Steroid Injection Combined with Miniscalpel-Needle Release in the Treatment of Carpal Tunnel Syndrome vs. Steroid Injection Alone: A Randomized Controlled Study

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Subo Zhang ◽  
Fei Wang ◽  
Songjian Ke ◽  
Caina Lin ◽  
Cuicui Liu ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Action Potential ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Steroid Injection ◽  
Sensory Nerve ◽  
Controlled Study ◽  
Injection Group ◽  
Tunnel Syndrome ◽  
Release Group

Objectives. Carpal tunnel syndrome (CTS) is one of the most common nerve entrapment syndromes, which has a serious impact on patients’ work and life. The most effective conservative treatment is steroid injection but its long-term efficacy is still not satisfactory. The aim of this study was to evaluate the effectiveness of steroid injection combined with miniscalpel-needle (MSN) release for treatment of CTS under ultrasound guidance versus steroid injection alone. We hypothesized that combined therapy could be more beneficial. Methods. Fifty-one patients with CTS were randomly allocated into two groups, namely, steroid injection combined with MSN release group and steroid injection group. The therapeutic effectiveness was evaluated using Boston Carpal Tunnel Questionnaire (BCTQ), cross-sectional area (CSA) of the median nerve, and four electrophysiological parameters, including distal motor latency (DML), compound muscle action potential (CMAP), sensory nerve action potential (SNAP), and sensory nerve conduction velocity (SNCV) at baseline, 4 and 12 weeks after treatment. Results. Compared with baseline, all the parameters in both groups showed statistically significant improvement at week 4 and week 12 follow-up, respectively (P<0.05). When compared with steroid injection group, the outcomes including BCTQ, DML, CMAP, SNCV, and CSA of the median nerve were significantly better in steroid injection combined with MSN release group at week 12 after treatment (P<0.05). Conclusions. The effectiveness of steroid injection combined with MSN release for CTS is superior to that of steroid injection alone, which may have important implications for future clinical practice. This Chinese clinical trial is registered with ChiCTR1800014530.

scholarly journals Change to movement and morphology of the median nerve resulting from steroid injection in patients with mild carpal tunnel syndrome

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Hyunseok Moon ◽  
Byung Joo Lee ◽  
Donghwi Park
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Aspect Ratio ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Steroid Injection ◽  
Nerve Compression ◽  
Median Nerve Compression ◽  
Significant Difference ◽  
Before And After ◽  
Tunnel Syndrome

Abstract There are conflicting hypotheses regarding the initial pathogenesis of carpal tunnel syndrome (CTS). One hypothesis characterizes it as inflammation of the median nerve caused by compression, while another hypothesis characterizes CTS as non-inflammatory fibrosis of the subsynovial connective tissue (SSCT). This study aimed to investigate the differences in the ultrasonography parameters before and after a steroid injection, which is effective for CTS, to elucidate the initial pathogenesis of CTS and the mechanisms of action of the injected steroid. Fourteen hands from 14 healthy participants and 24 hands from 24 participants with mild CTS were examined. Dynamic movement and morphology of the median nerve before and after steroid injection were measured. There was no significant difference in the normalized maximal distance of the median nerve, which reflects the degree of fibrosis in the SSCT indirectly, during finger and wrist movements before and after the injection among patients with CTS (p > 0.05). Among the parameters that indirectly reflects the degree of median nerve compression, such as normalized maximal change in the aspect ratio of the minimum-enclosing rectangle (MER), maximal change in the median nerve perimeter, and maximal value of the median nerve cross-sectional area (CSA), statistically significant differences were not observed between values of the normalized maximal change in the aspect ratio of the MER and maximal change in the median nerve perimeter, during finger and wrist movements recorded before and after the injection in patients with CTS (p > 0.05). However, multivariate logistic regression analysis revealed that the change in the normalized maximal value of the median nerve CSA, according to finger and wrist movement was correlated with the administration of the steroid injection (p < 0.05). In conclusion, compared to that noted before steroid injection, the median nerve CSA noted during finger and wrist movements changed significantly after injection in patients with mild CTS. Given the improvement in median nerve swelling after steroid injection, but no improvement in the movement of the median nerve during finger and wrist movements, median nerve swelling due to compression (rather than fibrosis of the SSCT may be the initial pathogenesis of early-stage (mild) CTS, and the fibrous changes around the median nerves (SSCT) may be indicative of secondary pathology after median nerve compression. Further studies are required to validate the findings of our study and confirm the pathogenesis of CTS.

Sonographic median nerve change after steroid injection for carpal tunnel syndrome

2018 ◽  
Vol 58 (3) ◽  
pp. 402-406 ◽  
Author(s):  
Jia-Chi Wang ◽  
Kon-Ping Lin ◽  
Kwong-Kum Liao ◽  
Yue-Cune Chang ◽  
Kevin A. Wang ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Steroid Injection ◽  
Tunnel Syndrome

scholarly journals Is Palmar Cutaneous Branch of the Median Nerve More Swollen in Carpal Tunnel Syndrome?

2021 ◽  
Vol 45 (4) ◽  
pp. 325-330
Author(s):  
Ha Mok Jeong ◽  
Young Ha Jeong ◽  
Joon Shik Yoon
Keyword(s):  
High Resolution ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
The Other ◽  
Cross Sectional ◽  
Palmar Cutaneous Branch ◽  
Cutaneous Branch ◽  
Tunnel Syndrome ◽  
Impairment Severity

Objective To investigate the characteristics of the palmar cutaneous branch of the median nerve (PCBMN) in patient with carpal tunnel syndrome (CTS) using high-resolution ultrasound.Methods Fourteen healthy volunteers (17 wrists) and 31 patients with CTS (41 wrists) were evaluated by high-resolution ultrasound. All patients were classified into three groups based on the electrophysiologic CTS impairment severity: mild, moderate, and severe. Using high-resolution ultrasound, the cross-sectional areas (CSAs) of the PCBMN were measured at the proximal wrist crease, bistyloid line, and distal wrist crease, and the largest CSA was defined as the maximal CSA.Results The maximal CSA of the PCBMN of the control, mild, moderate, and severe CTS groups were 0.27±0.08, 0.30±0.07, 0.35±0.10, and 0.47±0.13 mm2, respectively. The maximal CSA of the PCBMN was significantly larger in the severe CTS group than in the other groups.Conclusion The PCBMN could be concomitantly affected in patients with severe CTS.

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.

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