The Modified Ultrasound-Guided Distal-to-Proximal Carpal Tunnel Injection With Median Nerve Hydrodissection: A Retrospective Safety Review of 827 Procedures

Hand ◽  
2019 ◽  
pp. 155894471986171
Author(s):  
Kathy Guo ◽  
Logan McCool ◽  
Hao Wang ◽  
Danzhu Guo ◽  
Danqing Guo
Keyword(s):  
Soft Tissue ◽  
Median Nerve ◽  
Nerve Injury ◽  
Vascular Injury ◽  
Carpal Tunnel ◽  
Side Effect ◽  
Ultrasound Guided ◽  
Surrounding Soft Tissue ◽  
Safety Review ◽  
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.

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

PM&R ◽  
2017 ◽  
Vol 9 ◽  
pp. S214-S214
Author(s):  
Michael Schaefer ◽  
Ana M. Garcia ◽  
Jose A. Rosa Padilla
Keyword(s):  
Median Nerve ◽  
Carpal Tunnel ◽  
Ultrasound Guided ◽  
Rare Finding ◽  
Tunnel Injection

CLINICAL AND ELECTROPHYSIOLOGICAL COMPARISON OF DIFFERENT METHODS OF SOFT TISSUE COVERAGE OF THE MEDIAN NERVE IN RECURRENT CARPAL TUNNEL SYNDROME

2008 ◽  
Vol 62 ◽  
pp. 194-200 ◽  
Author(s):  
Nicolas M. Stütz ◽  
Andreas Gohritz ◽  
Alexander Novotny ◽  
Udo Falkenberg ◽  
Ulrich Lanz ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Soft Tissue ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Soft Tissue Coverage ◽  
Tunnel Syndrome

scholarly journals Litigation Following Carpal Tunnel Release

Hand ◽  
2018 ◽  
Vol 14 (4) ◽  
pp. 466-470 ◽  
Author(s):  
Nishant Ganesh Kumar ◽  
Nicholas Hricz ◽  
Brian C. Drolet
Keyword(s):  
Median Nerve ◽  
Nerve Injury ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Hand Surgery ◽  
The United States ◽  
Fellowship Training ◽  
Malpractice Claims ◽  
Predominantly Female ◽  
Median Nerve Injury

Background: Carpal tunnel release (CTR) is the most common hand surgery operation performed in the United States. While serious complications are rare, they can be life-altering to patients. In some cases, patients will pursue malpractice claims against the surgeon. This study aimed to understand the patient, procedure, and surgeon factors involved in CTR malpractice litigation. Methods: The Westlaw legal database was queried for all recorded CTR malpractice cases resulting in jury verdicts and settlements. Only cases directly related to injury after CTR were included in this study. Cases were reviewed to determine plaintiff demographics, defendant training, liability, injury, outcomes, and monetary awards. Results: Ninety-two unique cases were identified. Plaintiffs were predominantly female (n = 65, 71%). Most surgeons were orthopedic-trained (n = 37, 52%). Only 27% of defendants (n = 19) were hand fellowship-trained. Only 19% of cases resulting in a monetary award were against surgeons who had hand fellowship training. The majority of cases (n = 61, 66%) were found in favor of the defendant. Monetary awards averaged $305 923 (range = $12 000-1 338 147), while settlements averaged $266 250. Alleged liability was most for surgeon negligence (n = 69, 75%) with a third of cases resulting in monetary awards. Median nerve injury was claimed in 41 cases (45%), with 17 (41%) resulting in monetary awards. Conclusion: Although CTR is generally safe and effective, some patients will experience complications. Median nerve injury was the most common reason for successful litigation in this study. Adequate training and experience in hand surgery may lower the risk of injuries resulting in successful malpractice suits.

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

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.

ENDOSCOPIC CARPAL TUNNEL RELEASE AND CONGENITAL ANOMALIES OF THE MEDIAN NERVE

Hand Surgery ◽  
2003 ◽  
Vol 08 (02) ◽  
pp. 265-270 ◽  
Author(s):  
Andrew V. Cavallo ◽  
Philip G. Slattery ◽  
Richard J. Barton
Keyword(s):  
Median Nerve ◽  
Nerve Injury ◽  
Carpal Tunnel ◽  
Congenital Anomalies ◽  
Carpal Tunnel Release ◽  
Effective Means ◽  
Open Release ◽  
Endoscopic Carpal Tunnel Release ◽  
Endoscopic Release

Endoscopic release has been shown to be a safe and effective means of carpal tunnel decompression. The surgeon needs to be aware of the variations in the anatomy of the median nerve in order to minimise the risk of nerve injury. In this series of 748 endoscopic carpal tunnel releases, six were found to have variations in the median nerve anatomy, in two patients conversion to open release was necessary.

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

Hand ◽  
2018 ◽  
Vol 15 (1) ◽  
pp. 54-58 ◽  
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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