Severe Median Nerve Injured After Local Corticosteroid Injection in A Carpal Tunnel Syndrome Patient ——A Case Report

Mapping Intimacies ◽

10.21203/rs.3.rs-72319/v1 ◽

2020 ◽

Author(s):

Haiying Zhou ◽

hui lu

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Corticosteroid Injection ◽

Preoperative Assessment ◽

Case Presentation ◽

Tunnel Syndrome ◽

Perfect Recovery ◽

Carpal Tunnel Syndrome Patient ◽

Nerve Release

Abstract Background The corticosteroid injection is known to be an effective and safe treatment for carpal tunnel syndrome, no serious complications was reported in previous literature. We report a severe median nerve injured case after corticosteroid injection. Case presentation: A 55-year-old female patient was admitted to our hospital because of numbness in her right finger for 10 years. Total six corticosteroid injections were performed in the past 2 years, and the symptoms did not relief significantly. She underwent ligament resection and median nerve release. The median nerve epineurium thickened and the scar was obvious during the surgery. The patient made a perfect recovery after surgery. Conclusions: The accurate preoperative assessment and personalized treatment are very important for peripheral nerve entrapment disease.

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Case 14

10.1093/med/9780190603434.003.0018 ◽

2018 ◽

Author(s):

Bashar Katirji

Keyword(s):

Clinical Practice ◽

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Nerve Conduction ◽

Nerve Conduction Studies ◽

Case Presentation ◽

Peripheral Polyneuropathy ◽

Tunnel Syndrome ◽

Internal Comparison

Carpal tunnel syndrome is the most common entrapment neuropathy encountered in clinical practice. It is also the most common reason for referral to the electromyography laboratory. The anatomy of the median nerve and the carpal tunnel are outlined in details in this case presentation. The recommended nerve conduction studies needed to make a diagnosis are outlined. This includes internal comparison nerve conduction studies in which the median nerve is compared to a neighboring nerve such as ulnar or radial nerves, as well as the inching studies across the carpal tunnel. Finally, special situations are emphasized including severe carpal tunnel syndrome, carpal tunnel syndrome associated with peripheral polyneuropathy, carpal tunnel syndrome in the presence of Martin–Gruber anastomosis, and carpal tunnel syndrome during pregnancy.

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Re: Median nerve damage following local corticosteroid injection for the symptomatic relief of carpal tunnel syndrome

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934097318 ◽

2009 ◽

Vol 34 (1) ◽

pp. 135-136 ◽

Cited By ~ 7

Author(s):

Marc C. Swan ◽

Kerstin Oestreich

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Corticosteroid Injection ◽

Symptomatic Relief ◽

Nerve Damage ◽

Tunnel Syndrome ◽

Local Corticosteroid Injection

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Median Nerve Injury in Ultrasound-Guided Hydrodissection and Corticosteroid Injections for Carpal Tunnel Syndrome

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-1140-5717 ◽

2020 ◽

Author(s):

Yi-Chih Hsu ◽

Fu-Chi Yang ◽

Hsian-He Hsu ◽

Guo-Shu Huang

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Clinical Data ◽

Vascular Injury ◽

Carpal Tunnel ◽

Corticosteroid Injection ◽

Tunnel Syndrome ◽

Flattening Ratio ◽

Median Nerve Injury ◽

Corticosteroid Injections

Abstract Purpose Permanent nerve damage after corticosteroid injection has been suggested when symptoms of median nerve injury (MNI) are irreversible. We assess the outcomes of MNI and their association with ultrasonography (US)-guided hydrodissection and the following corticosteroid injection for symptomatic carpal tunnel syndrome (CTS). Methods US-guided hydrodissection and the following corticosteroid injections were administered to 126 CTS patients. Occurrence of MNI, clinical data, and post-hydrodissection findings were evaluated. Post-hydrodissection findings included vascular injury during hydrodissection, altered echogenicity, reduced flattening ratio, and increased cross-sectional area of the MN at the inlet of the carpal tunnel (MN-CSA-Inlet) on ultrasonography after hydrodissection. The relevance of MNI with respect to these clinical data and findings was determined. The outcome was rated using Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scores. Results Nine patients suffered MNI (incidence, 7.1 %) but improved significantly at follow-up. Clinical data and vascular injury during hydrodissection, altered echogenicity, and reduced flattening ratio after hydrodissection were unrelated to prolonged transient MNI (p > 0.05). MNI was significantly associated with increased CSA (p = 0.005). A CSA increase > 2 mm2 after hydrodissection yielded the greatest performance (0.979) for MNI in the receiver operating characteristic analysis. Decreases in BCTQ scores after injection did not differ significantly between groups with and without MNI (p > 0.05). Conclusion MNI during hydrodissection may be reversible. MNI is indicated by an increase in MN-CSA-inlet immediately after hydrodissection.

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