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

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.

Comparison of Borderline Ultrasound and Nerve Conduction Studies for Carpal Tunnel Syndrome

Hand ◽  
2020 ◽  
pp. 155894472096496
Author(s):  
Cory Demino ◽  
John R. Fowler
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Nerve Conduction Studies ◽  
Threshold Values ◽  
Cutoff Values ◽  
Number Of Patients ◽  
Tunnel Syndrome ◽  
Median Neuropathy

Background Choosing cutoff values for nerve conduction studies (NCS) and ultrasound cross-sectional area (CSA) in the diagnosis of carpal tunnel syndrome (CTS) is critical in determining the diagnostic accuracy of the tests. The goals of this study were to: (1) determine the sensitivity and specificity of various electrodiagnostic and ultrasound threshold values for diagnosis of CTS; and (2) determine the number of hands that underwent NCS and ultrasound that were within 10% of threshold values. Methods A total of 309 hands of 235 patients were included in this study. Diagnosis of median neuropathy was made based on NCS by the independent physician performing the NCS. Criteria analyzed included distal motor latency of 4.4+ ms, distal sensory latency of 3.6+ ms, difference in median-ulnar mixed nerve palmar latency of 0.4+ ms, and CSA of the median nerve of 10+ mm2. Results Median neuropathy was diagnosed in 235 hands, whereas 74 hands were found not to have median neuropathy. Overall, 141 hands (46%) had at least 1 of the 3 electrodiagnostic variables within 10% of the diagnostic cutoff values, and 137 hands (44%) had a median nerve CSA within 10% of 10 mm2. By performing ultrasound in addition to NCS for each patient, an additional 65 hands (21%) had a definitive diagnosis on at least 1 of the 2 diagnostic modalities. Conclusions Ultrasound and NCS yielded a similar number of patients within 10% of their diagnostic threshold values. When used together, the number of patients with a nonborderline diagnosis on at least 1 diagnostic modality was increased substantially.

scholarly journals Efficacy of Local Corticosteroid in Idiopathic Carpal Tunnel Syndrome: A Randomized Controlled Trial

2013 ◽  
Vol 28 (1) ◽  
pp. 10-15
Author(s):  
Anis Ahmed ◽  
Md Rafiqul Islam ◽  
Hasan Zahidur Rahman ◽  
Md Moniruzzaman Bhuiyan ◽  
Sukumar Majumder ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Steroid Injection ◽  
Corticosteroid Injection ◽  
Controlled Trial ◽  
Oral Steroid ◽  
Steroid Group ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome ◽  
Local Steroid Injection

Background: Carpal tunnel syndrome (CTS) is a common health problem in Bangladesh especially among women. It causes significant morbidity and reduces work output in affected patients. There are few treatment options available like oral steroid, steroid injection, UST, surgical treatment etc. Considering the cost, time and consequence of surgery, short term nonsurgical management is desirable e.g. local steroid injection in the affected limb. Therefore a comparative analysis is necessary to understand the efficacy of local steroid injection.Objective: To evaluate the efficacy of local corticosteroid injection in the treatment of idiopathic carpal tunnel syndrome. Methods: 60 idiopathic CTS patients divided into two groups by randomization. One group received Inj. Triamcinolone 30 mg close to carpal tunnel and other group received oral steroids. Efficacies of treatmemt were compared in between groups.Result: The mean age of two groups were 37.5 ± 10.5 and 37.0 ± 10.24 years respectively (p = 0.272) and Majority of the patients in both treatment groups (76.7% in local steroid and 80% in oral steroid groups, p = 0.754) were female. Relief from tingling sensation and nocturnal awakening was higher in the steroid injection receivers (100% and 86.7% respectively) than that in the oral steroid receivers (6.9% and 3.4% respectively) during evaluation of outcome at the end of 3 month. End point treatment shows that none but SNAP at wrist in the local steroid group improved significantly better than that in the oral steroid group (16.2 ± 10.5 vs. 12.4 ± 6.3, p =0.039). No major side effects occurred in local steroid group except depigmentation in injected area 3 (10%) cases.Conclusion: It may be concluded that local steroid injection is an effective treatment of idiopathic carpal tunnel syndrome. But long-term efficacy of steroid injection remains uncertain.Bangladesh Journal of Neuroscience 2012; Vol. 28 (1): 10-15

PEDICLED HYPOTHENAR FAT FLAP FOR MEDIAN NERVE COVERAGE IN RECALCITRANT CARPAL TUNNEL SYNDROME

Hand Surgery ◽  
2000 ◽  
Vol 05 (01) ◽  
pp. 33-40 ◽  
Author(s):  
Ch. Mathoulin ◽  
J. Bahm ◽  
S. Roukoz
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Anatomical Study ◽  
Ulnar Artery ◽  
Transverse Carpal Ligament ◽  
Carpal Tunnel Surgery ◽  
Tunnel Syndrome ◽  
Normal Nerve Conduction

We report the use of a hypothenar pedicled fat flap to cover the median nerve in recalcitrant carpal tunnel syndrome. Forty-five patients with recurrent symptoms after previous carpal tunnel surgery were included in this study. Patients with incomplete release of the transverse carpal ligament were not included. We performed an anatomical study on 30 cadavers. The original technique with the section of the deep branch of ulnar artery was modified. The flap could be transferred onto the median nerve without stretching. The median follow-up was 45 months (range, 12–80 months). Pain completely disappeared in 41 patients with normal nerve conduction. Based on clinical and electromyographic signs, the global results showed excellent results (49%), 19 good results (45%), two average results (4.5%) and two failures (2%). The use of a hypothenar pedicled fat flap to cover the median nerve in recalcitrant carpal tunnel syndrome is a simple and efficient technique which improves the trophic environment of the median nerve and relieves pain.

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